Payments > Insurance Payments

Overpayment scenario

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Hfitting18:
I am very new to this position and am learning as I go. Not sure how to proceed here - a personal injury patient's auto insurance covered 80% of our claim. I submitted to BCBS for secondary, they covered 100% of the allowable amount resulting in a total payment of $256.26 on a $210 claim.

Here is a detailed breakdown of remits:
Charge $210
Auto paid $168
Patient CoPay due $42
Submitted to secondary
BCBS paid $88.26
Contractual Adjustment of $121.74

I think BCBS didn't take the prior payment information into consideration? Any direction is greatly appreciated :)

kristin:
I don't deal with auto accident claims, so my knowledge is limited, but I would think that they would be the only insurance you could bill in this scenario, and it shouldn't have gone to BCBS at all. Someone will correct me if I am wrong.

That said, when you submitted claim to BCBS, did you include EOB from auto insurance payment? If not, that could be part of the issue.

Michele:
Actually the patient would be responsible for the 20%.  If the claim is the result of an auto accident I do not believe that BC will pay.  I would contact BC to see if they are aware that the patient was in an auto accident.

PMRNC:
Was the BCBS plan an "Individual" plan? If so then patient carries additional coverage which could result in refund to patient. ONLY if the BCBS plan was individual plan.  IF IT was individual policy you may need to also refund the co-pay.

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