Detailed Answer
When you receive a medical or provider statement of account—sometimes called a billing statement or “patient account summary”—you’ll see several sections outlining charges, payments, adjustments, and your remaining balance. Under Wyoming law, providers must issue clear, itemized statements so patients can understand how insurance or government program payments affect their account (see Wyo. Stat. § 26-6-105, requiring written statements upon request: https://wyoleg.gov/statutes/compress/Title26.pdf).
1. Charges Section
This initial section lists all services, supplies, and treatments you received, with their corresponding billed amounts. It typically appears at the top of your statement.
2. Payments and Adjustments Section
Immediately below the charges, you’ll find a section titled “Payments,” “Insurance Payments,” or “Payments & Adjustments.” Insurance or government program payments appear here as either:
- Insurance Payment: The amount your health insurer (private or employer-sponsored) remitted directly to the provider.
- Medicare/Medicaid Payment: For patients covered by federal programs, you’ll see separate lines for “Medicare Payment” or “Medicaid Payment.” Wyoming Medicaid follows federal billing rules (42 C.F.R. § 447, https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-447).
- Contractual Adjustment: The difference between the provider’s billed charge and the amount the insurer or program agreed to pay under their contract. This adjustment never becomes your responsibility.
3. Patient Responsibility Section
After all payments and adjustments, the statement shows your share—copayments, coinsurance, or deductibles. It may be labeled “Amount You Owe,” “Balance Due,” or “Patient Responsibility.”
4. Additional Notes or Remarks
Providers sometimes include explanations for adjustments, claim rejections, or denials in a “Notes” or “Remarks” section. Review these to understand any unusual adjustments.
This article is for informational purposes only and does not constitute legal advice. If you have specific questions about your statement or rights under Wyoming law, consult a qualified attorney or billing specialist.
Helpful Hints
- Verify each service date and description in the Charges section matches your records.
- Match insurance payments to your Explanation of Benefits (EOB) from your insurer.
- Look for “Contractual Allowance” or “Adjustment”—these are discounts you don’t owe.
- If a payment or adjustment seems missing, contact your insurer or the provider’s billing department.
- Keep all statements and EOBs organized—Wyoming law requires providers to keep records for at least 5 years (Wyo. Stat. § 26-4-107, https://wyoleg.gov/statutes/compress/Title26.pdf).
- Ask for an itemized statement in writing if you receive an unexplained balance.