Insurance billing

[CALI]

I have a request from a pt who wishes I fax claims to her so she can submit to another insurance company that I am unaware of; I have previously billed Anthem & have rec'd payment leaving a $20 copay; my concern is that the second insurance will pay the allowed amount directly to the doctor which will create an overpayment; is there a way I can avoid this? do I refund the pt the difference?
Thank you,

[DMK]

We have several patients who self bill their secondary insurance.  Usually the secondary only picks up the deductible, or co-pay leftover from the primary.  If the secondary pays more than the primary's allowed amount, it shouldn't be a problem to adjust the write off.

[PMRNC]

I have a request from a pt who wishes I fax claims to her so she can submit to another insurance company that I am unaware of; I have previously billed Anthem & have rec'd payment leaving a $20 copay; my concern is that the second insurance will pay the allowed amount directly to the doctor which will create an overpayment; is there a way I can avoid this? do I refund the pt the difference?

I agree with DMK, only I will add that you can do a secondary claim w/out an assignment if you don't want to deal with the write/off (unless it's BCBS). Also a mini note.. I won't FAX PHI or any thing unless the patient completes another authorization which includes permission to fax to the number specified. I work with a lot of mental health providers and you'd be surprised at what length the x spouses or non custodial parent's will go to in order to get information. I require a special permission authorization which has the fax number, the patient or custodial parent's signature and it's a ONE time auth for specified information. C Y A

[CALI]

Thank you; my concern is that there will be a credit balance after the secondary pays and I adjust the insurance write off; do I send the pt the credit?

[DMK]

No, you would adjust the write off in your system.  It's technically not an overpayment if the secondary pays more than the primary.

[PMRNC]

No, you would adjust the write off in your system.  It's technically not an overpayment if the secondary pays more than the primary.

The exception however would be a secondary/individual plan.. sometimes there will be a credit. Individual plans are paid with premium's the insured pays out of pocket and many times patients are over insured and not realizing it.   You will still take all the par adjustments but if there is an overpayment that should be refunded to the patient.

[CALI]

I'm confused; I don't need to apply the insurance adjustments from either insurance payment?

[PMRNC]

There's really not enough info to say. Was the primary carrier a par carrier? Are you par with secondary? Did patient pay anything? From the info given I can tell you that you will adjust off the par adjustment if par, from the primary, but can't say about secondary. You mentioned there was balance left of $20 copay, might be the secondary will pay the copay, don't have enough info on the secondary to really say.

[CALI]

Thank you, I appreciate your help