Detailed Answer
On a Missouri statement of account, payments from insurance companies or government programs appear in the “Payments and Adjustments” section. This section lists all credits applied to the patient’s account and reduces the total balance due. Each entry typically includes:
- Payer Name: The insurer or program (e.g., Blue Cross Blue Shield, Medicare, MO HealthNet).
- Payment Date: The date the claim was processed or paid.
- Paid Amount: The dollar amount the payer remitted.
- Contractual Adjustment (Write-off): The difference between the provider’s charge and the amount the insurer contractually agrees to pay.
- Patient Responsibility: Any remaining balance after the insurer’s payment and adjustment.
Under Missouri law, insurers must pay or deny clean claims within 45 days of receipt.1 Once the insurer issues payment, the provider posts that credit to the statement. Government programs—such as Medicare and MO HealthNet—also post payments here. Providers may group these entries by program name to maintain clarity.
Example layout on a typical statement:
| Date | Description | Charges | Payments & Adjustments | Balance |
|---|---|---|---|---|
| 01/10/2024 | Office Visit | $200.00 | $200.00 | |
| 02/05/2024 | BCBS Payment | –$150.00 | $50.00 | |
| 02/05/2024 | Contractual Adjustment | –$30.00 | $20.00 |
Since providers contract with insurers or government programs, any shortfall (contractual adjustment) cannot be billed to the patient. The patient sees only the net balance they owe after all insurance or program payments are applied.
1. Missouri Revised Statutes § 376.427 – Prompt payment by insurers (revisor.mo.gov).
Helpful Hints
- Review your Explanation of Benefits (EOB) alongside the statement to confirm insurer payments match.
- Look for line items labeled as “Adjustment” or “Write-off”—these are contractual discounts.
- If you see a payment posted under the wrong payer name, request a corrected statement.
- Medicare and MO HealthNet payments often show a program identifier (e.g., “Part B” or “MOHN”).
- Contact the billing department if the posted payment date significantly lags the insurer’s payment date.
- Retain all EOBs and statements for your records in case of billing disputes.
Disclaimer: This article is for informational purposes only and does not provide legal advice. Consult a qualified attorney or billing specialist for guidance on your specific situation.