Author Topic: Who gets the overpayment here?  (Read 1690 times)

bumbleb

  • Newbie
  • *
  • Posts: 29
Who gets the overpayment here?
« on: June 18, 2009, 09:24:10 PM »
Hi!  I'm still pretty new here, and think this forum is great!  I have recently started at a PT office, and have a ques. about who gets an overpayment.

We had a patient with 3 insurances.  Medicare, BC/BS and Aetna.  We billed MC and they paid the 80% allowable, and for some reason wasn't forwarded to BC/BS, so I billed them as secondary.  They only paid $8.xx on the $84.xx left.  So I billed Aetna, sending both of the previous EOBs.  They mailed me a check last week and one yesterday for 100% of Medicare charges on the dates they've paid so far. 

Normally (on the rare occasions a pt had 3 ins), the 2nd and 3rd each will pay the 20% minus copays/deduct, so we reimburse the pt the few dollars over. 

The previous office manager/biller told me not to pay back the ins co until they notice and request it, but in this instance I think I need to call Aetna...what are your thoughts??

Thanks, bren

swamy

  • Newbie
  • *
  • Posts: 8
Re: Who gets the overpayment here?
« Reply #1 on: June 19, 2009, 01:49:42 AM »
Hi Bren, yes I beleave Aetna should get refunded back their money, later when they realises that they paid more money, they request you the money refund, if we are not refunding the balance on time, they will again charge for that and take refund.

or they may even do offset that amount in the future payments for that provider claims. so call aetna and find it out

swamy

PMRNC

  • Hero Member
  • *****
  • Posts: 4218
    • One Stop Resources & Networking for Medical Billers
Re: Who gets the overpayment here?
« Reply #2 on: June 19, 2009, 06:26:26 AM »
Not Necessarily...this could be an overinsured patient, in which case the patient actually would get the credit, to confirm this call the BCBS and Aetna and find out which policy is the supplemental.
Many seniors don't realize they are overinsured, it might seem like they shouldn't get more for a visit to the doctor, however they are paying more in premiums.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

bumbleb

  • Newbie
  • *
  • Posts: 29
Re: Who gets the overpayment here?
« Reply #3 on: June 19, 2009, 05:52:04 PM »
Thanks...I have seen patients with 3 insurances before, but usually the 3rd will just pay at most the 20% Medicare doesn't.  But Aetna was paying the full 100%. 
This pt is 90+ years old, and I wasn't working when she had PT, but the insurances were listed in 1 2 3 order, with a note for me verifying the order.  I was told if BC/BS didn't pay the full 20% to bill Aetna.
I'll deal with it all on Mon and see what they say.

Bren