Where Insurance or Government Program Payments Appear on a Tennessee Statement of Account
Detailed Answer
A statement of account is a billing summary that shows all charges, payments, credits, and adjustments for services you received. In Tennessee, insurers (private or state-run programs such as TennCare) must provide clear information on what they covered and what you owe.
On most statements you will see three main sections:
- Charges for Services: Lists all procedures, tests, or visits with their full price.
- Payments and Adjustments:
- Insurance Payments: Private insurance or a government program payment (e.g., Medicare or TennCare) appears here as a credit. It often reads “Insurance Payment,” “TennCare Payment,” or “Medicare Remittance.”
- Adjustments / Write-Offs: The difference between the provider’s charge and the insurer’s allowable amount. It may say “Contractual Adjustment” or “Insurance Adjustment.”
- Balance Remaining: The amount you owe after all insurance and program payments and adjustments are applied.
Example: You receive an invoice showing a professional fee of $1,000. Your private insurer pays $700. The provider may then write off $200 as a contractual adjustment under their insurer contract, leaving you responsible for $100. On the statement you will see:
- Charges: $1,000
- Insurance Payment: – $700
- Contractual Adjustment: – $200
- Balance Due: $100
No specific Tennessee statute dictates the exact layout of a medical billing statement, but state law requires insurers to provide an Explanation of Benefits that clearly shows how claims are paid under Tenn. Code Ann. § 56-7-101 et seq. (see Tennessee Department of Commerce & Insurance).
Helpful Hints
- Review each line item—look for labels like “Insurance Payment,” “TennCare,” or “Medicare.”
- Check “Contractual Adjustment” to understand write-offs agreed upon between provider and payer.
- If a payment entry isn’t clear, contact the billing office or insurer for an Explanation of Benefits (EOB).
- Compare your statement with any EOBs you’ve received to ensure matching amounts.
- If you find discrepancies, request an itemized bill and dispute any errors promptly under Tennessee’s prompt pay and fair billing practices.
Disclaimer: This blog post is for informational purposes only and does not constitute legal or medical advice.