Detailed Answer
A statement of account—often called an Explanation of Benefits (EOB) or billing statement—lists all charges, payments, adjustments, and the remaining balance for services you received. It shows how much you owe and how much third parties, such as insurance companies or government programs, have paid on your behalf.
Key Components of a Statement of Account
- Charges: The billed amount for each service or item.
- Payments: Amounts paid by you and by third-party payers.
- Adjustments: Contractual discounts or write-offs negotiated with insurers or government programs.
- Balance Due: The net amount you owe after all credits.
Where Insurance and Government Program Payments Appear
Insurance payments and reimbursements from government programs (such as Medicare or Medicaid) typically appear in the Payments or Credits section of your statement. Common line-item labels include:
- Insurance Carrier Payment: The amount your private insurer paid directly to the provider.
- Medicare/Medicaid Payment: The amount a federal or state health program paid.
- Contractual Adjustment: A permitted discount reflecting the difference between provider charges and the amount the payer agrees to pay.
Ohio Law on Billing Transparency
Ohio Admin. Code §3701-84-01 requires healthcare facilities to clearly list all charges, payments received (including insurance or government program payments), adjustments, and the patient’s remaining balance. See OAC 3701-84-01 for details.
Disclaimer: This article is for educational purposes only and does not constitute legal advice. Consult a qualified attorney for guidance on your specific situation.
Helpful Hints
- Compare your EOB with your statement to match payments and adjustments.
- Look for “Contractual Adjustment” entries to see insurer-negotiated discounts.
- Verify statement and EOB dates to ensure all payments are posted.
- Contact the billing department if any payment or adjustment is unclear.
- Keep records of all remittance advices and billing communications.