Detailed Answer
On a standard healthcare provider statement of account, you will see three main parts: total charges, payments and adjustments, and patient responsibility. Insurance and government program payments appear in the “Payments and Adjustments” section. Each entry will list the payment date, the payer (for example, Blue Cross Blue Shield or New Mexico Medicaid), and the paid amount. You may see line items labeled “Insurance Payment,” “Third-Party Payment,” or “Medicaid Payment.” These entries reduce your total balance owed.
Under New Mexico law, providers must itemize all payments and adjustments clearly on patient statements. See NMSA 1978, §59A-23B-42 (requiring insurers to supply itemized payment data) (link). Government program payments, such as Medicaid or Medicare, also appear in this same section. New Mexico Administrative Code requires providers to post Medicaid payments as adjustments on the patient’s account (see 8.317.2.11 NMAC (link)). Both types of payments reduce the “Total Charges” to calculate your “Patient Responsibility.”
How to Read These Line Items
- Date: When your insurer or program remitted payment.
- Payer: Name of the insurance company or government program.
- Amount Paid: The exact dollar value received by the provider.
- Description: Often shown as “Allowed Amount,” “Adjustment,” or “Payment.”
- Remaining Balance: Automatically updates after each payment.
Helpful Hints
- Compare your statement with the Explanation of Benefits (EOB) from your insurer for accuracy.
- Verify that the payer name matches your insurer or government program.
- Look for negative numbers or parentheses indicating credits.
- Contact your provider’s billing office if you spot missing or incorrect payments.
- Keep copies of all EOBs and statements for your records.
Disclaimer: This article provides general information and does not constitute legal or medical billing advice. Consult qualified professionals for advice tailored to your situation.