What Is the Term for Monies Owed to a Patient From the Provider?

Medical billing can seem complicated, with money flowing in various directions between patients, healthcare providers, and insurance companies. Understanding the specific financial terms used in this system helps individuals grasp their obligations and rights.

Understanding Monies Owed to Patients

The term for monies owed to a patient from a healthcare provider is “Accounts Payable to Patient.” This represents a liability for the provider. Situations leading to these amounts include overpayments made by the patient, refunds for services that were canceled or not fully rendered, or credit balances resulting from adjustments by insurance companies. For instance, if a patient pays an estimated co-pay upfront and the insurer later covers a larger portion, the excess payment becomes an amount payable to the patient.

Providers must process these refunds within a specific timeframe. If an overpayment is discovered, the provider must notify the patient within 90 days and issue the refund within 30 days of that notification or the patient’s request. For Medicare beneficiaries, providers have up to 60 days to return overpayments.

Key Related Medical Billing Terms

Beyond amounts owed to patients, other terms define financial transactions in healthcare. “Accounts Receivable” refers to money owed to the healthcare provider from patients or insurance companies for services already provided. This is considered an asset on the provider’s financial statements, representing expected future cash inflows. It encompasses various outstanding payments, such as unpaid deductibles, co-pays, or balances not covered by insurance.

“Medical Debt” describes outstanding medical bills that a patient owes to a healthcare provider or a collection agency. This differs from “Accounts Payable to Patient” because medical debt is a financial obligation for the patient, not the provider. It can arise from high deductibles, services not covered by insurance, or unexpected medical emergencies. Medical debt can significantly impact a patient’s financial stability, potentially leading to lower credit scores or delayed access to future care.

An “Explanation of Benefits” (EOB) is a document sent by an insurance company to a patient after a claim has been processed. While not a bill, the EOB details the services received, the total charges, the amount the insurance company paid, and the portion the patient is responsible for. It provides transparency regarding how an insurance claim was handled and helps patients understand their financial responsibility, including any deductibles, co-payments, or co-insurance applied.