Detailed Answer
This is not legal advice. This article explains where payments from insurance carriers or government health programs typically appear on a patient’s statement of account under Nevada law.
1. Statement Layout Under Nevada Law
Under Nevada Revised Statutes (NRS) Chapter 629, health care providers must issue an itemized statement of account upon request. The statement breaks down charges, payments, adjustments and the remaining balance. You will see separate sections for:
- Charges – Total billed charges for services rendered.
- Payments & Adjustments – All amounts credited to the account, including insurance and government program payments.
- Patient Responsibility – Balance owed by the patient after credits.
2. Location of Insurance or Government Program Payments
Insurance or government program payments (e.g., Medicare, Medicaid) appear in the “Payments & Adjustments” section of the statement. Each entry typically includes:
- Date of Payment: When the insurer or program paid.
- Payer Name: Insurance company or program (e.g., “Nevada Medicaid”).
- Amount Paid: The exact sum remitted to the provider.
- Reference Number: Claim or check number for tracking.
Example snippet from a statement:
Date Description Charges Payments & Adjustments Balance ------------------------------------------------------------------------------------------------ 04/10/2024 Office Visit CPT 99213 $150.00 — $150.00 04/15/2024 Payment – Blue Shield — $90.00 (EOB 12345) $60.00 04/20/2024 Payment – Nevada Medicaid — $50.00 (Claim #67890) $10.00
3. Statutory Reference
NRS 629.481 requires that an itemized statement of account clearly list credits and payments received. This ensures transparency and helps patients track what third-party payers have covered.
Helpful Hints
- Review your Explanation of Benefits (EOB) to match insurance payments on your statement.
- Look for terms like “Adjustment,” “Contractual Allowance,” or “Patient Liability”—these explain why billed charges differ from what you owe.
- If a payment is missing, compare the insurer’s EOB date with your provider’s statement date.
- Contact your billing office for clarifications on any line item you don’t recognize.
- Keep all statements and EOBs filed together to simplify future disputes or audits.