Medical Billing Forum

Billing => Billing => Topic started by: CALI on January 11, 2012, 03:40:06 PM

Title: 2 separate insurance plans
Post by: CALI on January 11, 2012, 03:40:06 PM
Hi All!

Recieved payment from 2 different insurance plans for a DOS. We applied both payments and applied the insurance discount from 1 insurance.  We are left with a credit balance.  How do we handle the balance? 
CALI
Title: Re: 2 separate insurance plans
Post by: billingmom on January 11, 2012, 07:05:21 PM
Obviously, they overpaid you so you need to post one payment and refund the extra payment back to the insurance.  At this point you will have to post an adjustment to take the credit balance off.   good luck ......
Title: Re: 2 separate insurance plans
Post by: Michele on January 12, 2012, 07:02:23 AM
Did one process as primary and the other as secondary?  What types of plans are they?  These things matter in determining if there is an overpayment and who is entitled to it.  For example, if the patient purchased insurance such as AFLAC, etc, they may be entitled to the difference.  If both plans are employer group plans and both processed as primary, then there is a COB issue that needs to be resolved.  Can't tell without knowing more about the two plans.

Title: Re: 2 separate insurance plans
Post by: PMRNC on January 12, 2012, 07:41:33 AM
I agree with Michele, you can't assume there was an overpayment as there are still a lot of people considered overly insured and would be entitled to that excess payment. You need to determine if there is coordination of benefits, what type of plans were these, etc. That will tell you whether an overpayment is necessary to one of the carriers or the excess belongs to the patient.
Title: Re: 2 separate insurance plans
Post by: CALI on January 13, 2012, 02:33:23 PM
Hi,
The patient has two separate Anthem Blue Cross plans, both are primary and there is not a COB.
After I apply the first insurance payment and adjustment there is a patient responsibility; I was thinking of applying the second insurance payment to satisfy the patent's responsibility and that would leave a credit which  is due the patent, correct?
Title: Re: 2 separate insurance plans
Post by: PMRNC on January 13, 2012, 03:18:13 PM
You have to make sure they are individual plans and/or one doesn't know of the other first. If its determined that one or both are individual plans then the credit belongs to patient. Many times I've had it happen where two plans pay as primary only to find out one didn't know of the other.
Title: Re: 2 separate insurance plans
Post by: CALI on January 16, 2012, 12:48:29 PM
Thanks everyone