Medical Billing Forum

Payments => Patient Billing => Topic started by: Tlaughlin on June 10, 2009, 03:13:44 PM

Title: secondary insurance
Post by: Tlaughlin on June 10, 2009, 03:13:44 PM
My office manager and I are having a discussion about taking the adjustment when the 2nd insurance pays. We have already taken the adjustment from the primary insurance. My question is are we required to take the adjustment from the 2nd insurance as well? or can we take the larger of the 2 adjustments and balance bill the patient?
thanks for any input!!!!!!!!
Title: Re: secondary insurance
Post by: PMRNC on June 10, 2009, 05:33:34 PM
If you par with both you take the adjustment from the higher allowable:

Example:
Doctor pars with Aetna And Cigna
Doctor bills $100 Office visit  Aetna Allows $75  and pays $65 - Patient Copay =$10
Secondary allows $80, subtracts Aetna's payment of $65 and pays $15.00

Adjustment is: $20.00
Title: Re: secondary insurance
Post by: swamy on June 25, 2009, 01:00:52 AM
when secondary ins pays, we will not adjust the balance, we bill to patient or if Patient 3rd insurance exist we bill with Primary and Secondary EOBs attached.

Only primary allowed amount that we consider for the payment, till we get that amount we bill secondary, patient or 3rd insurance.
Title: Re: secondary insurance
Post by: PMRNC on June 25, 2009, 06:48:20 AM
You don't go by the primary, that's not how COB works, you take the higher allowed amount. In the poster's question they were par with both so the question was which to use as the allowable and the answer is the "higher" amount, that won't always necessarily mean the primary.
Title: Re: secondary insurance
Post by: Amit_Nischal on July 16, 2009, 09:10:28 AM
If you are par with the insurance. Then adjustment would be taken on the basis of which inusrnace has hight allowede amount.

Eg:- Prim Insurance Aetna : $100 bill : insurance allowed $75,
       Sec  Insurance Cigna : $100 bill, insurance allowed $80,

In this case , will post $ 20 as w/o, Cigna will pay $5 addition to Aetna's payment.

Thanks,
Amit