Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney or billing specialist to address your specific situation.
Detailed Answer
In Washington, health care providers must issue an itemized statement of account (often called a billing statement) that lists total charges, payments, and adjustments. Insurance and government program payments appear in the section commonly labeled “Payments and Credits” or “Patient Payments and Adjustments”. This section offset charges and shows how much the insurer or program paid on your behalf.
How It’s Displayed
- Payment Date: The date the insurer or government program issued payment.
- Payer Name: The insurance company or government program (e.g., Medicaid, Medicare).
- Payment Amount: The dollar amount credited to your account.
- Description: A brief note such as “Insurance Payment,” “Medicare Adjustment,” or “Medicaid Payment.”
Statutory Basis
Washington law requires hospitals to provide a complete, itemized statement upon request. It must show the services, charges, and amounts paid by third parties.
- RCW 70.41.110 – Itemized statement of patient account; contents and delivery.
Under RCW 48.43.005, insurers must promptly remit payment and clearly identify payments on the provider’s statement. This ensures transparency and prevents billing surprises.
Helpful Hints
- Review the Payments and Credits section first to verify insurer or program contributions.
- Match payment dates on your bank or insurer explanation of benefits (EOB) to the statement.
- Look for any adjustments – these may include co-pays, deductibles, or write-offs.
- If line items are unclear, contact the provider’s billing department and request an explanation or a more detailed statement.
- Keep copies of all EOBs and statements; they help you reconcile differences.