Sample VCU Itemized Billing Statement

This is an example of an itemized billing statement from VCU.

It lists each service provided, the date of each service, the cost of each service, and has a total amount of costs for all services.

It shows the insurance payments and adjustments, and any payments the patient has made.

It shows a balance on the remaining bill.

VVF needs this document to correctly calculate how much may be paid on a claim, and to distinguish crime-related medical services from non-crime-related medical services.