Request an itemized statement

Best first step: Have your statement number, account number, patient name, date of service, and facility or department ready before requesting an itemized statement.

• An itemized statement gives more detail about charges than a standard bill.
• You can request one when a charge looks unfamiliar, insurance needs more detail, or you want to review the balance.
• The statement may show dates of service, charge categories, payments, insurance adjustments, and remaining balance.
• Facility, provider, lab, imaging, emergency, and Brookhaven charges may appear separately.
• An itemized statement does not automatically mean the charge is wrong or that the balance will change.
• If you find a possible error after reviewing it, ask billing for a charge or insurance review.

Statement type	What it usually includes
Standard bill	Summary balance, due amount, payment options, account information, and basic visit or service details.
Itemized statement	More detailed charge lines, service dates, charge categories, payments, insurance adjustments, and remaining balance.
Explanation of benefits	Insurance document showing how the claim processed, what insurance paid, and what the patient may owe.

• A charge description is unclear or unfamiliar.
• The balance looks higher than expected.
• You received more than one bill after the same care episode.
• Your insurance plan asks for charge details.
• You need documentation for reimbursement, school, work, legal, or tax purposes.
• You want to compare the bill with your insurance explanation of benefits.
• You need to review payments, adjustments, discounts, or financial assistance.
• You are requesting billing review and need a detailed statement first.

• Patient name and account number.
• Date of service or date range.
• Facility, department, or service area.
• Charge descriptions or charge categories.
• Individual charge amounts.
• Insurance payments, adjustments, or denials.
• Patient payments, refunds, or credits.
• Financial assistance or discount adjustments, if applied.
• Remaining balance after payments and adjustments.

Important: An itemized statement can help explain charges, but it is not the same as a medical record, explanation of benefits, insurance appeal, or charge correction.

• Provider notes, test results, or medical records.
• Full clinical details about why a service was ordered.
• Insurance coverage rules or denial reasons beyond basic claim activity.
• Detailed coding explanations for every billing code.
• Proof that a charge is incorrect.
• Automatic balance correction or payment-plan approval.

1. Locate the statement or account number on your bill.
2. Confirm the patient name and date of birth.
3. Identify the date of service or care episode you want itemized.
4. Specify whether the request is for Alchemilla, Brookhaven, emergency care, lab, imaging, outpatient care, or another service.
5. Ask whether the itemized statement includes facility charges, provider charges, or both.
6. Ask how the statement will be delivered.
7. Ask how long it may take to receive.
8. Ask whether billing review is needed after you receive it.

• Patient full name and date of birth.
• Account number, statement number, or invoice number.
• Date of service or approximate date range.
• Facility or department, if known.
• Whether you need all charges or only a specific charge reviewed.
• Whether the request is for insurance, reimbursement, personal review, or billing review.
• Preferred delivery method, if available.
• Best phone number or email for follow-up questions.

• Ask whether each bill is connected to the same date of service.
• Ask whether one bill is for facility charges and another is for provider charges.
• Ask whether lab, imaging, pharmacy, or specialty services billed separately.
• Ask whether Brookhaven and Alchemilla charges appear on separate statements.
• Ask whether any statement is a corrected statement or reminder notice.
• Ask whether duplicate bill review is needed.

• Compare dates of service.
• Compare billed charges, insurance payments, and adjustments.
• Check whether the correct insurance plan appears on the statement.
• Check whether the claim is pending, denied, adjusted, or paid.
• Ask billing if the account appears different from your explanation of benefits.
• Contact your insurance plan for questions about coverage, deductible, coinsurance, copay, or denial reasons.

• Compare the statement with the care received.
• Compare the statement with your explanation of benefits.
• Check whether payments and adjustments appear correctly.
• Mark any unfamiliar charge descriptions or dates.
• Ask whether a charge explanation, claim review, or corrected statement is needed.
• Ask whether payment deadlines are paused or changed while review is open.
• Ask about payment-plan or financial-assistance options if the balance is correct but difficult to pay.

Contact billing as soon as possible if the itemized statement is needed because of a deadline, collection notice, insurance appeal, missing payment, duplicate payment, or urgent account issue.

• You received a final notice or collection notice.
• An insurance appeal or reimbursement deadline is approaching.
• A payment was withdrawn but does not appear on the account.
• You believe the same bill was paid twice.
• You need proof of charges or payment quickly.
• You cannot pay the balance and need payment-plan or financial-assistance options.

Billing support is separate from medical care. If you need medical or behavioral health help, do not wait for a billing response.