Understanding Insurance and Government Program Payments on Your Statement of Account in West Virginia
Disclaimer: This article is for educational purposes only and is not legal advice.
Detailed Answer
When you review a statement of account issued by a service provider—such as a medical office, hospital or lender—you will see charges, payments and adjustments listed in separate columns or sections. Under West Virginia law, payments received from insurance companies and government programs (like Medicare or Medicaid) must appear clearly on this statement to ensure transparency and accuracy.
1. Payments ↑ Adjustments Section
On most statements, you will find a column or block titled “Payments & Adjustments,” “Credits Applied” or something similar. Within that area, look for line items labeled:
- Insurance Payment — amount your private insurer paid
- Medicare Payment — amount paid under Medicare
- Medicaid Payment — if your claim was covered by Medicaid
- Other Government Payment — any state or federal program payment
Each line shows the date the payment was applied, the payer’s name (e.g., Anthem Blue Cross, WV Medicaid), and the amount credited against the original charge.
2. Example Statement Layout
| Date | Service Description | Charge | Payments & Adjustments | Patient Responsibility |
|---|---|---|---|---|
| 01/10/2024 | Office Visit | $150.00 | $120.00 (Insurance Payment) | $30.00 |
| 01/10/2024 | Lab Work | $200.00 | $160.00 (Medicare Payment) | $40.00 |
In this example, insurance and government program payments reduce the total balance, leaving only the patient’s share due.
3. West Virginia Legal Requirements
West Virginia Code requires that healthcare providers furnish clear, itemized statements upon request. See WV Code §30-3-3, which mandates maintenance of patient records and access to billing details. Transparent statements help you verify payments and challenge any errors.
Helpful Hints
- Review your Explanation of Benefits (EOB) from your insurer alongside the provider’s statement to confirm matching payment amounts.
- Look for adjustment codes (e.g., CO45, PR1) which explain why a payment was reduced or denied.
- If a government program paid less than expected, contact the provider billing office for clarification and itemized details.
- Always compare the total of your payments and adjustments to the ending balance to ensure accuracy.
- Keep copies of all statements and EOBs for your records in case you need to dispute charges.