Disclaimer: This article is for informational purposes only and does not constitute legal advice. For guidance specific to your situation, consult a qualified attorney.
Detailed Answer
In Oklahoma, a medical or service provider’s statement of account—the document summarizing charges, payments and balances—must clearly separate provider charges from payments made by third-party payers such as insurance companies or government programs (e.g., Medicare, Medicaid). Typically, you will see these entries under a section labeled “Payments and Adjustments” or “Insurance Payments.” Here’s how it breaks down:
1. Charges
This section lists the full billed amount for each service or procedure.
2. Payments by Insurance or Government Programs
Amounts covered and paid by private health insurers or public programs appear as negative line items in the payments column. You may see a description such as “Insurance Payment,” “Medicare Payment,” “Medicaid Payment” or the specific plan name. These entries reduce the total amount you owe.
Under Oklahoma law, insurers must provide an explanation of benefits showing how they calculated their payment. See 36 O.S. § 6102 (requiring carriers to furnish a statement of benefits and payments). 36 O.S. § 6102
3. Contractual Adjustments or Write-Offs
To comply with the insurer contract, providers often “adjust off” a portion of the billed charge. These appear as “Contractual Adjustment” or “Write-Off” entries. They reflect the difference between your provider’s standard fee and the insurer’s negotiated rate. This adjustment further reduces the patient’s responsibility.
4. Patient Responsibility
After all third-party payments and adjustments, the remaining balance is your responsibility. It appears as the final line item labeled “Patient Due,” “Balance Remaining” or “Amount You Owe.”
How to Read Your Statement of Account
- Locate the “Charges” column to see the provider’s full fee schedule.
- Find the “Payments” or “Insurance Payments” section to identify insurer or government payments.
- Review “Contractual Adjustments” to confirm the insurer’s negotiated write-off.
- Check the “Patient Responsibility” to know what you owe.
Helpful Hints
- Always compare the insurer’s Explanation of Benefits (EOB) with your provider’s statement to ensure consistency.
- If you spot discrepancies, contact both your insurer and the provider’s billing department immediately.
- Keep all statements and EOBs for at least three years in case of audits or disputes.
- Ask your provider to send a detailed itemization if a statement seems unclear.
- Oklahoma law limits interests and late fees on unpaid balances. Review 36 O.S. § 3622 for more details.