Disclaimer: This article provides general information and does not constitute legal advice. Consult a Texas attorney for guidance tailored to your situation.
Detailed Answer
In Texas, a statement of account from your health care provider or billing office breaks down all financial activity related to your care. Insurance or government program payments appear as credit entries that reduce your total balance. You will typically find these payments in the following sections:
1. Payments or Credits Section
Most statements include a column labeled ‘Payments’, ‘Payments Received’, or ‘Credits’. Here, insurers and government payers (such as Medicare or Texas Medicaid) show the dollar amounts they paid on your behalf. This section may list:
- Date of payment: When the payment was processed.
- Payer name: The insurance company or government program.
- Payment amount: The exact sum paid on your claim.
2. Adjustments or Write-Offs
Under the Texas Insurance Code Chapter 542 (Prompt Payment of Claims), insurers must send an Explanation of Benefits to providers, detailing payments and any contractual adjustments. On your statement, these appear as ‘Adjustments’, ‘Contractual Allowances’, or ‘Write-Offs’. They reflect the difference between the provider’s full charge and the insurer’s negotiated rate. (See Tex. Ins. Code Ann. § 542.)
3. Government Program Remittance Advice
For Medicaid services in Texas, providers receive a remittance advice that mirrors the statement of account. These payments and adjustments show as part of your overall credits. See Tex. Health & Safety Code § 32.039 for Medicaid provider payment rules.
After listing all payments and adjustments, the statement recalculates your remaining patient responsibility. This is the balance you owe after insurer or government program contributions.
Helpful Hints
- Review each line item carefully; payments reduce your balance, while adjustments represent negotiated write-offs.
- If a payment entry looks incorrect or is missing, compare it to your Explanation of Benefits (EOB) or remittance advice.
- Keep copies of all statements, EOBs, and remittance advices to reconcile bills and payments.
- Contact your provider’s billing office or insurer for clarification of any unfamiliar terms.
- If you face billing disputes, you may file a complaint with the Texas Department of Insurance via their complaint portal.