Detailed Answer
In Utah, most providers and creditors organize a statement of account into three key sections: Charges, Payments & Adjustments, and Balance Due. Insurance or government program payments always appear in the Payments & Adjustments section as credits that reduce your balance.
How Payments & Adjustments Work
- Insurance Payments: Listed with the date the insurer posted the payment, the insurer name (for example, Blue Cross Blue Shield), and the paid amount. These entries often read “Insurance Payment” or include your policy number.
- Government Program Payments: Posted similarly but labeled by program (Medicare, Medicaid, or other state/federal programs). They show the payment date and program name.
- Contractual Adjustments (Write-Offs): The difference between the provider’s full charge and the insurer or program’s negotiated rate. These appear as adjustments and are distinct from actual payments.
Example (Hypothetical Facts)
• Date of Service: January 5, 2023
• Billed Charge: $200
• Insurance Payment (Blue Cross): $150 on February 10, 2023
• Contractual Adjustment: $30
• Patient Responsibility Remaining: $20
In this example, the statement shows a $150 credit under “Insurance Payments,” a $30 credit under “Adjustments,” and a $20 balance due under “Patient Responsibility.”
Legal Framework in Utah
Utah law does not mandate a single format for every statement of account, but healthcare providers must comply with price transparency requirements under Utah Code § 26-21a-102. You can review the statute here: Utah Code § 26-21a-102. Insurers must also follow prompt-payment rules under Utah Code § 31A-22-621.
Disclaimer: This article provides general information about where third-party payments appear on statements of account under Utah law. It is not legal advice. For advice about your specific situation, consult a licensed attorney.
Helpful Hints
- Review the “Payments & Adjustments” section first to spot insurer or program credits.
- Compare each entry with your Explanation of Benefits (EOB) to verify accuracy.
- Look for payer identifiers like “Medicaid,” “Medicare,” or your insurer’s name.
- Contact the billing department promptly if you see missing or duplicate entries.
- Request an itemized statement if the summary lacks detail or you suspect errors.