Where Do Insurance or Government Program Payments Appear on the Statement of Account?
Disclaimer: This article is for informational purposes only and does not constitute legal advice.
1. Overview of a Statement of Account
A statement of account is a detailed record of all charges, payments, and adjustments applied to an account over a specific period. It typically includes:
- Charges or Billed Services
- Payments and Adjustments
- Balance Due
2. Location of Insurance Payments
Insurance payments generally appear under the “Payments and Adjustments” section of the statement. Providers often label these line items as:
- Insurance Payment or Carrier Payment: The amount your insurer paid directly to the provider.
- Contractual Adjustment: The difference between the provider’s standard charge and the insurer’s negotiated rate, sometimes called the “write-off.”
South Dakota law requires clear itemization of these amounts on patient billing statements. For example, see SDCL § 36-29A-2, which mandates that health care providers list insurer payments and adjustments by line item. (sdlegislature.gov/Statutes/Codified_Laws/36-29A-2)
3. Government Program Payments (Medicare, Medicaid)
Similar to private insurance, government programs such as Medicare and Medicaid appear under “Payments and Adjustments.” They may be labeled:
- Medicare Payment or Medicaid Payment
- Government Adjustment: The write-off or negotiated reduction under federal or state law.
Providers in South Dakota must comply with the Health Care Claims Transparency Act, which ensures that Medicare and Medicaid payments are clearly shown. (See SDCL § 36-29A-3: sdlegislature.gov/Statutes/Codified_Laws/36-29A-3)
4. Understanding Patient Responsibility
Once insurance or government payments and adjustments post, the statement shows your remaining patient responsibility. This amount may include:
- Deductibles
- Co-payments
- Co-insurance
- Non-covered services
Your patient responsibility is the final Balance Due on the statement.
5. South Dakota Statutes and Your Rights
Under SDCL § 36-29A, you have the right to receive a clear itemization of all charges, payments, and adjustments on your medical billing statement. You may request an explanation if any line items are unclear.
Helpful Hints
- Review each line item: Check that insurance and government program payments match your Explanation of Benefits (EOB).
- Watch for “write-offs”: Contractual adjustments reduce your balance but are not your responsibility.
- Contact the provider: If amounts are unclear, ask for a detailed explanation or corrected statement.
- Keep records: Retain EOBs and statements until you verify all charges and payments.
- Seek assistance: If disputes persist, consider contacting the South Dakota Department of Health or a qualified attorney.