Disclaimer: This article is for educational purposes only and does not constitute legal advice. Consult an attorney or qualified professional for guidance on your specific situation.
Detailed Answer
In Virginia, when a healthcare provider or similar business issues a statement of account (sometimes called a patient statement or ledger), it typically breaks down the total charges, payments received, and adjustments or write-offs. Insurance or government program payments appear in the Payments and Adjustments section of the statement. These entries reduce the patient’s outstanding balance.
Specifically, the provider will list each payment from a third-party payer—such as a private insurer, Medicare, or Medicaid—by date, payer name, and amount. You will often see a line item labeled “Insurance Payment” or “Third-Party Payment,” followed by any related “Adjustment” or “Contractual Write-Off.” For example:
- Date of Payment: The date the insurer or program remitted funds.
- Payer Name: The insurance carrier or government program (e.g., Blue Cross Blue Shield, Medicare, Medicaid).
- Payment Amount: The dollar amount credited to the account.
- Adjustment: Any contractual write-off or denial that adjusts the charged amount.
Under Virginia’s Insurance Code, insurers must provide an Explanation of Benefits (EOB) or electronic remittance advice outlining these payments. See Va. Code § 38.2-3418 (requiring insurers to furnish an explanation of benefits within 30 days of claim receipt): https://law.lis.virginia.gov/vacode/title38.2/chapter34/section38.2-3418/. Providers use this information to post payments on the patient’s statement of account.
How to Read the Payments Section
- Check the Dates: Verify that each payment date on the statement matches the date on your EOB or remittance advice.
- Match Payer Names: Ensure the payer listed (e.g., Medicare) matches the insurance card or program name.
- Confirm Amounts: The payment amount should equal the insurer’s remittance less any contractual adjustments.
- Review Adjustments: Understand any write-offs or denials. These reduce the billed charges based on your provider’s contract with the insurer.
Helpful Hints
- Keep your EOBs or remittance advices in a secure folder for reconciliation.
- Compare statement entries with bank deposits or electronic payment reports.
- If a payment is missing or amounts differ, contact your provider’s billing office and your insurer.
- Ask for an itemized statement if you only receive a summary.
- Check deadlines for billing disputes under Va. Code § 8.01-413.3 (medical billing statute of limitations): https://law.lis.virginia.gov/vacode/title8.01/chapter4/section8.01-413.3/.