On a hospital bill what is the difference between CHARGES PAYMENTS and ADJUSTMENTS?

Answer 1

I received a bill for a stitches removal appointment (in the ER). It is a chart that says:

SERVICES | CHARGES | *
11/15/15 Emrgncy Room | 323.00 | -----
11/27/15 HMSA Adjustment | ------ | 666.00
12/03/15 HMSA Payment | ------ | -924.40
Totals | 323.00 | 258.40
PLEASE PAY THIS AMOUNT | 64.60

(* this column says PAYMENTS & ADJUSTMENTS)

I can't figure out what this means and how the numbers add up. What is the $924? And the $666?

Answer

You may want to call your medical insurance company HMSA for clarification about your bill. The billing amounts don't total properly, maybe because the actual bill formatting is lost or their may be an error in your copying from the bill to above.

What is Happening

Their is more than one billing rate for any medical activity. There is the private billing rate which is used for someone without any insurance. Then there are the negotiated billing rates with the insurance companies, medicare, and medicaid which the medical community accepts, possibly in return for getting the volume of patients covered by the insurance.

• Emergency room line should be the private emergency room rate.
• HMSA Adjustment is the difference between the private rate and what the insurance company has negotiated to pay for the treatment.
• HMSA Payment should be the amount the ER is actually getting from HMSA. It is the negotiated price minus any deductible and copay.
• PLEASE PAY THIS AMOUNT is what you have to pay the ER. It is the copay or deductible amount you owe as part of your contractual agreement with HMSA.

Answer 2

Charges are the amount that the hospital bills for a service. Payments are the amount that the hospital has received in payment for those services- either from the patient, or the patient's insurance company. Adjustments are changes to the charges- usually as a result of an agreement that the hospital would have with an insurance company,