Medical: Itemized Statements / Bills

What is required on an itemized bill/statement?

✅  Date of service

✅  Patient's name

✅  Provider's name and address (using the office letterhead is great!)

✅  List of services (CPT codes or a full description of service)

✅  Charge for EACH service

✅  Private/cash pay discount amount*"

✅  Total paid (or due) after discounts

*If the provider cannot provide an itemized bill showing the cost before discount and the discount amount, they can hand write that information on the bill and then sign their name next to that information.

"Some providers just have a 'cash rate' for private pay patients and therefore do not have a total cost before discounts or a private pay discount amount to show on the statement.  That is okay!

Providers are familiar with standardized billing forms such as CMS-1450, UB-04, CMS-1500 and HCFA-1500.  Any of these documents should suffice for an Itemized bill!

An itemized bill/statement does NOT have the word "Estimate" on it.

The Austin Stone Health & Wellness Plan is unique, in that we get great healthcare coverage while also participating in stewarding ministry dollars. You have the opportunity to see these savings each time that you use the plan. How? By asking your providers for discounts!

Examples:

Prescription Itemized Statement: