Medical Billing Forum

Payments => Insurance Payments => Topic started by: tzdermpath on October 24, 2012, 09:47:53 AM

Title: Paid by two insurances as Secondary
Post by: tzdermpath on October 24, 2012, 09:47:53 AM
I am from an independent laboratory, we do not see actual patients but receive specimens from all over the US. We often receive incomplete or wrong information but are at the mercy of what is given to us. We have quite a few patients that have Medicare as primary and then we won't receive the secondary information but it is forwarded by Medicare. Sometimes we get paid by two supplemental insurances and we are unsure who is the actual supplemental. How should we be handling these patients accounts?  Can anyone point me to a good website or information portal that will help guide me with this. We are in the state of OH but deal with patients in over 32 states.

I need a sample letter to send to those supplemental insurances so we can attempt to find out who the money belongs to.

Thank you in advance for any help!
Title: Re: Paid by two insurances as Secondary
Post by: rdmoore2003 on October 24, 2012, 02:16:00 PM
I would contact the provider that sent the information to you.  If that doesnt work, contact Medicare (or whatever Primary). 
Title: Re: Paid by two insurances as Secondary
Post by: rdmoore2003 on October 24, 2012, 02:18:29 PM
also, do you have any contracts with these referrals (providers, facilities, etc)?  I used to work for an urgent care facility, we had contract with lab for these kinds of issues.
Title: Re: Paid by two insurances as Secondary
Post by: Michele on October 30, 2012, 07:23:45 AM
Most Medicare carriers have websites now.  Usually insurance info can be verified on the website.  That may be helpful.  As for a letter, I would write up one and use that as your template.
Title: Re: Paid by two insurances as Secondary
Post by: tzdermpath on October 30, 2012, 12:15:12 PM
Thank you  for replying. Unfortunately I am in a sticky situation with being a laboratory who receives info from numerous offices. Some offices are great at providing patient  information sheets but some will not take the time to do it and upper management is unwilling to force the issue. We also receive outdated information all the time. We have had situations where the patient has not lived at that address or has not have that insurance for many years, therefore this makes it hard too.

Almost all of our situations are secondary insurances after medicare. Medicare pays their part then we have UHC pay $20 and then BC/BS pays $20 and the account now has a credit of $20 and we don't know who to send the money back to. We will call UHC and they will say we show it correct in our records, don't send the money back. We call Bc/Bs and they say the same thing.... now what? I also need to have this conversation in writing to have proof. (UHC and Bc/BS are just example insurances, not always those two). I am hoping that someone out there can provide me with a sample letter to be able send to these insurances.

 
Title: Re: Paid by two insurances as Secondary
Post by: Michele on November 04, 2012, 05:03:05 PM
The problem is even with a sample letter you don't know who you are supposed to be refunding.  If you call both and they both claim that they paid correctly who do you return it to?  If you send it to the patient and one of them decides to do an audit then you are responsible for repaying them, even if you sent it to the patient.  There is no easy answer.
Title: Re: Paid by two insurances as Secondary
Post by: tzdermpath on November 06, 2012, 09:23:31 AM
Michelle,

The advice I have gotten says to notify both insurances and then hold the money. That it should never go back to the patient unless I have received written request from the insurance to do so. I think as long as I have notified both insurances to co-oridinate benefits and leave it up to them then I am covered legally. That is my understanding at least. 

I was able to get a sample letter so we are going to try that and then verifiy other information from there.
Title: Re: Paid by two insurances as Secondary
Post by: Michele on November 07, 2012, 07:10:21 AM
I agree with the advice.  I would document everything very well, who you notified, when, and what they advised you. 
Title: Re: Paid by two insurances as Secondary
Post by: rdmoore2003 on November 07, 2012, 02:47:02 PM
also, now that you have a sample letter, you should have a contact for each facility you deal with.   once you have a contact person, you can send them your sample letter that way the contact can dispurse appropriately or even fill out for you.  i have a form that i made, its simply called "insurance tracking form".