Disclaimer: This article provides general information about Kentucky billing statements and does not constitute legal advice. Consult a qualified attorney for advice regarding your specific situation.
Detailed Answer
A statement of account, also known as a patient billing statement or an account statement, outlines all charges, payments, adjustments, and the remaining balance for services or products provided. Under Kentucky law and common billing practices, insurance payments and payments from government programs (such as Medicare, Medicaid, or the Kentucky Children’s Health Insurance Program) appear as credit entries that reduce the total amount owed.
Where to Find Insurance or Government Program Payments
On most statements, you will see columns or sections labeled:
- Payments — The total amount received from third-party payers.
- Insurance Payments — Specific line items showing amounts paid by private health insurers.
- Government Program Payments — Line items indicating payments from programs like Medicare or Medicaid.
- Adjustments — Contractual write-offs or discounts negotiated between the provider and the insurer or program.
These entries typically sit near the bottom of the statement under a heading such as “Payments & Adjustments.” The line items list the date of payment, the payer’s name, and the amount credited.
Example Layout
| Date | Description | Charges | Payments & Adjustments | Balance |
|---|---|---|---|---|
| 01/05/2023 | Consultation | $150.00 | — | $150.00 |
| 01/10/2023 | Insurance Payment (ABC Insurance) |
— | $120.00 | $30.00 |
| 01/10/2023 | Medicaid Payment (KY Medicaid) |
— | $20.00 | $10.00 |
In this example, insurance and Medicaid payments appear in the “Payments & Adjustments” column, reducing the total balance due.
Legal Considerations
Kentucky law requires insurers to handle and process claims in a timely manner. See KRS Chapter 304.17A for fair claims settlement practices. Providers must maintain accurate billing records and furnish an itemized statement upon request under the Kentucky Department for Public Health regulations.
Helpful Hints
- Review every entry for accuracy. Ensure payer names and amounts match your Explanation of Benefits (EOB).
- Contact your provider’s billing office if you spot an unexplained entry or discrepancy.
- If you suspect an underpayment or billing error, request an itemized bill and compare it with your EOB.
- Keep all documents, including insurance EOBs, government program notices, and billing statements, for at least 7 years.
- Consult an attorney or patient advocate if you face collection actions based on an incorrect balance.