Disclaimer: This article provides general information and does not constitute legal advice.
Understanding the Statement of Account
In Massachusetts, businesses and healthcare providers must issue a clear statement of account—sometimes called a patient ledger or billing statement—that lists all charges, payments, and adjustments related to services rendered. This document tracks how the total charges become your final balance.
Detailed Answer
1. Payments and Adjustments Section
Insurance and government program payments almost always appear under a section labeled “Payments and Adjustments,” “Credits,” or “Contractual Allowances.” That section breaks down:
- Insurance Payments: Once your insurer processes a claim, it issues an Explanation of Benefits (EOB) to you and the provider. The provider records the insurer’s payment as a credit line item, often labeled “Insurance Payment,” with the payment date and amount.
- Government Program Payments: Payments from Medicare, MassHealth, or other state-supported programs appear as separate line items, frequently under “Adjustments” or “Government Payments.” These credits reflect the amount the program agreed to pay.
2. Legal Requirements in Massachusetts
Massachusetts law requires insurers to send clear benefit statements. See M.G.L. c. 176J, §2 for the obligation to provide an Explanation of Benefits: M.G.L. c. 176J, §2. Providers must apply payments and adjustments promptly under the prompt-payment rules in M.G.L. c. 93, §49C: M.G.L. c. 93, §49C.
3. Confirming Your Balance
To ensure accuracy, compare:
- Total Charges – the full amount billed for services.
- Sum of Payments and Adjustments – all insurer and government credits.
- Patient Responsibility – what remains after subtracting payments and adjustments from total charges.
If the math aligns, the remaining balance should match any amount you owe.
Helpful Hints
- Check Your EOB: Match each payment on your billing statement to the corresponding Explanation of Benefits.
- Separate Line Items: Verify that private insurance payments and government program payments are listed separately.
- Verify Dates: Ensure payment dates on the statement match the dates on your EOB.
- Request an Itemized Bill: Under M.G.L. c. 93, §105, you have the right to request an itemized statement showing all services and payments: M.G.L. c. 93, §105.
- Address Discrepancies Promptly: If you spot an error, contact your provider or insurer within 60 days to preserve your rights to appeal or correct the record.