Billing Statement Instructions

Understanding Your Billing Statement

Please use this guide as a key to understanding your statements. There is important information contained in them, and understanding what to look for and the format you will find it in, will assist you in determining your payment amount.

The Top Portion

This portion contains your address information and our address as well. It also contains a form on the right side for you to make convenient credit card payments. Below the credit card form is your STATEMENT DATE. Your most recent statement will always be your most current statement. This is important to remember as sometimes the balance changes from month to month. You will be most accurate in determining your payment amount if you are using your most recent statement.

The PAY THIS AMOUNT field shows the TOTAL amount now assigned to your responsibility.

The ACCOUNT NBR (account number) is used by our office as an invoice number.

Please note that address changes and phone number changes can be indicated on the reverse side of this portion of the statement.

The Middle Portion

This part of the statement contains detailed information. It is divided into columns.

The DATE will show the date that the patient received services and the date that a payment or adjustment was posted (if applicable).
The DESCRIPTION OF SERVICE will list the patient name, provider seen and encounter number.
1. The encounter is a number assigned to the particular transaction and will probably not be helpful to you except as a reference for payments that you are making.
2. Listed under this section is a 5 digit code that is assigned to the procedure(s) completed this day. This is the code that we submit to the insurance company for you along with the diagnosis codes that were related to the procedure. If you are filing claims to your insurance using your statement, it will not include the diagnosis codes that your insurance company will likely need. It will speed up your claims process if you contact us about other methods for submitting your claim, either by you or by us.
3. If a payment or discount has been posted to the transaction, you will see it listed here. If you see an insurance payment with a 0.00 amount, please review the information supplied to you by your insurance company or contact them to find out why there is not a payment. If you still have questions after you have contacted them, please call us. We can let you know what they have told us.
4. It may be helpful to keep in mind that these amounts may not reflect the entire payment, ONLY THE PORTION THAT WAS APPLIED TO THIS PARTICULAR TRANSACTION.
The AMOUNT shows the original charge for the particular transaction. It may also include payments and/or adjustments to your bill.
The INSUR BALANCE (Insurance Balance) will display an amount that has not been paid or denied by your insurance plan. How do I handle problems with my insurance claims?
The PATIENT BALANCE column will display any amount that is due from you. It may be helpful to keep in mind that this amount may not reflect the entire payment from you or your insurance company.
The BALANCE will display the entire dollar amount billable on that line item. This is not the balance owed but is a total that you can compare to your insurance explanation of benefits.
Depending on the age of your services automatic computer generated message will appear right after the last transaction.

We are happy to provide you with a listing of all payments that you have made over the course of the year. Please allow us adequate time to prepare and mail that information to you before you need to turn it in.

The Bottom Portion

The outlined box in the lower right hand corner stating "PLEASE PAY THIS AMOUNT" is a repeat of the same field at the top of the statement. This amount is your responsibility to pay at the time the statement is received.

PLEASE PAY
THIS AMOUNT >> >> >> $

As always, if you have questions regarding your statement, please feel free to contact us immediately. We are always happy to assist you.

Great Plains Clinic P.C. does not combine accounts for patients over the age of 18. Any individual over 18 years of age will receive a separate statement due to HIPPA privacy reasons. Any minor children under the age of 18 will be placed under the parent of choice when registered the first time. The monthly statement will include the one parent and any minor children who may have balances due. Incase of divorce or separation the child's bill will be sent to the responsible party with whom the child resides. Court orders will need to be settled between the parties involved. Payment in full is requested upon receipt.

The business office can be reached at (701) 483-6017

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