Detailed Answer: Insurance and Government Program Payments on a Montana Statement of Account
A statement of account (often called a billing statement or invoice) summarizes all charges, payments, and adjustments for services you received. In Montana, providers generally follow industry standards and federal rules to prepare these statements. Payments made by insurance companies or government programs (like Medicare or Medicaid) appear as credits that reduce your balance. Here’s where to find them:
- Payments and Credits Section: Most statements include a section titled “Payments,” “Payments and Credits,” or “Activity.” Here you’ll see payments from your private insurer or a government program listed as line items with dates and amounts.
- Adjustments or Contractual Allowances: Insurance contracts and government programs often set an allowed amount. Any difference between your provider’s charge and the allowed amount shows up as an “Insurance Adjustment,” “Contractual Adjustment,” or “Allowed Amount.” This write-off reduces what you owe.
- Explanation of Benefits (EOB) References: Healthcare providers frequently attach or reference your insurer’s Explanation of Benefits. The statement may list “EOB Adjustment” or “Insurance Payment per EOB,” linking the payment to the negotiation your insurer completed.
- Balance Calculation: After listing charges, payments, and adjustments, the statement shows “Previous Balance” minus insurer or program payments and adjustments to arrive at “New Patient Balance.” This final figure is your responsibility.
Montana does not mandate a specific billing format, but providers must present clear and accurate information. For general insurance claim handling under Montana law, see Mont. Code Ann. Title 33, ch. 18. For Medicaid provider payment rules, see Mont. Admin. R. 37.86.
Disclaimer: This article is for informational purposes only and is not legal advice. Consult an attorney for legal guidance.
Helpful Hints
- Compare your statement to your insurer’s Explanation of Benefits to confirm payments match.
- Look for labels like “Payment,” “Adjustment,” or “Contractual Allowance.”
- Request an itemized bill if you need more detail about each charge and payment.
- Verify that the “Balance Calculation” correctly applies all insurance and program payments.
- Contact your provider’s billing department or insurer if you have questions about any line item.