# Can you help me read this medical statement? (Probably not...)

**URL:** <https://boards.straightdope.com/t/can-you-help-me-read-this-medical-statement-probably-not/685907>\
**Category:** In My Humble Opinion\
**Created:** [April 12, 2014, 1:14am UTC](https://boards.straightdope.com/t/can-you-help-me-read-this-medical-statement-probably-not/685907 "2014-04-12T01:14:54Z")\
**Posts on this page:** 3\
**Page:** 1

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**Author:** ![Frylock](https://avatars.discourse-cdn.com/v4/letter/f/ce7236/32.png) [@Frylock](https://boards.straightdope.com/u/Frylock)\
**Post date:** [April 12, 2014, 1:14am UTC](https://boards.straightdope.com/t/can-you-help-me-read-this-medical-statement-probably-not/685907/1 "2014-04-12T01:14:54Z")

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I don’t think this thing was designed to be understood…

It doesn’t help that I have very little experience with dealing with medical expenses of any kind. Not totally a hundred percent sure about how insurance works, in terms of procedure and process…

Well anyway, here’s what it says:

```auto

[font=courier]

                                                          Charges Payments/Adjustments Insurance Amount Patient Amount

Emergency Room: $938.00
Co-Payment: -$245
Default Self-Pay Refund Debit: $245
Hospital Services $938.00 $0 $938 $0

Outstanding balance: $0

```

I said “statement” above but I’ve just now realized that what I’m reading off of is not really a statement, it’s a page generated under the label “outstanding accounts.” There’s a different page I’d go to for “statements.”

My main questions are:

Is “insurance amount” the amount insurance paid, or the amount they’ve sent off to our insurance company to find out how much they _will_ pay? And what’s going on with the “default self-pay refund debit?” We did receive that check, and had no idea what to make of it. And why is the co-payment listed as $245 when in fact we paid $350 (as reflected on my bank statement)?

Of course these are all questions I will ultimately have to ask the hospital and my insurance company about. But that’s two and a half days away! I am hoping there are some things here that are usual enough for people to know what’s going on even though I (being unexperienced) don’t understand them.

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**Author:** ![panache45](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/panache45/32/64_2.png) [@panache45](https://boards.straightdope.com/u/panache45)\
**Post date:** [April 12, 2014, 2:44am UTC](https://boards.straightdope.com/t/can-you-help-me-read-this-medical-statement-probably-not/685907/2 "2014-04-12T02:44:58Z")

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I am on Medicare, plus separate insurance for Parts B-D. Whenever I incur any medical expense I get a statement that fills an entire sheet of paper. Though I’m a reasonably intelligent person, I cannot make any sense of it. I start on the upper left and try to follow the reasoning, but there doesn’t seem to be any.

An example: A couple of years ago I had cataract surgery in one eye. I received statements for the surgeon, the anesthesiologist, nurses, assistants, etc., etc., and it seemed like everyone was paid. Then, about a month later, I received a statement to the effect that $8,000.00 was charged for use of the building when the surgery was performed. Then it said that my insurance paid the amount in full.

I no longer even try to understand these things. If the “outstanding balance” is $0, I don’t need to understand anything else.

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**Author:** ![sitchensis](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sitchensis/32/4892_2.png) [@sitchensis](https://boards.straightdope.com/u/sitchensis)\
**Post date:** [April 12, 2014, 7:39am UTC](https://boards.straightdope.com/t/can-you-help-me-read-this-medical-statement-probably-not/685907/3 "2014-04-12T07:39:57Z")

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nm