Author Topic: Two primary insurances  (Read 3403 times)

kbolt

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Two primary insurances
« on: June 27, 2008, 04:48:56 PM »
What do you do when a patient has two primary insurances and the physician is contracted with both? I have a patient who has a group health plan and an individual policy that does not coordinate with other plans. Do I have to enter both discounts or just one? How will I process this payment? PLEASE HELP!!!

Tracy

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Re: Two primary insurances
« Reply #1 on: July 01, 2008, 05:41:56 PM »
The patient shouldn't have 2 primary. If they have a group plan through their work, then they wouldn't qualify for an indivdual plan that they purchased privatly(and why would you have one?) It sounds like the patient had private insurance and then qualified at their work for group and didn't cancel or let the individual plan know about the group plan. This is a problem for the patient. I would call the individual plan and let them know that the patient has a group plan

kbolt

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Re: Two primary insurances
« Reply #2 on: July 02, 2008, 08:23:00 AM »
I have talked to both insurance companies. The group plan states that they are primary and the individual plan would be secondary. When I call the other insurance with the individual plan, they tell me that the patient has a plan that does not coordinate with other insurances and the refund would go to the patient. But I'm still at a loss on which adjustments I should enter. I believe it is crazy if I have to enter both adjustments, b/c the patient would end up making more than us! At the same time, if I dont enter both would that be violating contracts? I do not understand either why the patient would have this, but I do know that it is possible but rare.

Michele

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Re: Two primary insurances
« Reply #3 on: July 03, 2008, 09:00:07 PM »
Hi,
   The patient may have a private plan that they pay for themselves that pays even if there is other insurance (like AFLAC).  The services are being paid for twice but it is ok.  You should bill both insurances, accept the payment from the group plan as the provider agrees to by participating.  Then take any patient responsibility (copay or coinsurance) from the private plan and refund the patient anything over that.  I know it seems strange but I have seen it on occasion.

Just when you think you've seen it all! 

Michele
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kbolt

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Re: Two primary insurances
« Reply #4 on: July 08, 2008, 03:18:58 PM »
First let me tell you thanks for trying to help me but I am still lost. I now understand that the overpmt will definitely go to the patient, but the amt of refund is still in question. Am I required to enter in both provider discounts from both insurances OR do I just enter one provider discount then both payments? This is a major concern, considering the discount amounts will go into affect when determing the amount to refund the patient. Also, in some cases, if I apply both discounts the patient could possibly receive a significant amount of more money than us!

This is way too confusing for me!


Tracy

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Re: Two primary insurances
« Reply #5 on: July 08, 2008, 06:38:38 PM »
I would like to know what the two insurances are and what state you live in. Aflac does not send a check to the provider they send the check to the patient so the second insurance shouldnt' be AFLAC. Also I am in Oregon and the individual plans here you cannot purcase if you are on a group insurance plan. Now we all know that when we talk to the "wonderful" employee's at the insurance companies they often don't know a darn thing. If you have an overpayment from an insurance company the insurance company is going to want a refund. DO NOT refund the patient any money if they have not paid you any. You don't want to send the patient a check and then 6 months down the road have the insurance company ask for the money back. If Primary paid oh lets say $1500.00 and wrote off $500 with a patient balance of $500 and the secondary paid $1500.00 and a write off of $500.00. You would only post the first write off and the secondary would get the refund for $1000.00.

Tracy

Michele

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Re: Two primary insurances
« Reply #6 on: July 10, 2008, 09:53:52 AM »
Hi,

   In order to help you more I need more info.  I don't want to give you the wrong answer.  Please tell me the amount charged, the amount paid by Ins 1, the write off by Ins 1, the amount paid by Ins 2, and the write off by Ins 2. 

I would also recommend that you call Ins 2 one more time and verify that they DO NOT coordinate benefits with Ins 1 and get the first and last name of the person you're speaking with.  DOCUMENT the date and time of the call and the person's name in the patient's chart.  Advise them that you are verifying this before refunding the patient and you would like them to document your call on their end.

Also, what are the two insurances?  Group plan thru employment and what??

Thanks
Michele
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kbolt

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Re: Two primary insurances
« Reply #7 on: July 10, 2008, 03:04:55 PM »
Total charge $108.00
Group insurance Benesys paid 56.92, write-off of 44.76, leaving pt responsibility of 6.32
Individual plan thru BlueCross BlueShield- paid 49.05, showing write-off of 46.69, leaving pt resp. of 12.26

With both payments and the Benesys write-off only the credit is $42.73. If I were to enter both write-offs the credit would be 89.42. I have documented who I spoke with at both insurances when they have stated that refund should go to patient. Also, we DO coordinate with both insurances unfortunately in this case.

Thanks for helping,
Kim in Louisiana


Michele

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Re: Two primary insurances
« Reply #8 on: July 14, 2008, 12:28:48 PM »
Wow, I have never heard of a BC plan that didn't coordinate!  That is a new one for me.  Anyway, I would definitely not apply both write offs.  I would calculate as follows:

Charge                       $108
Payment from Benesys     56.92
Write off from Benesys     44.76
____________________________
Balance                           6.32

Payment from BCBS          49.05
Keep Pt resp of                 6.32
______________________________
Send patient refund of       42.73

That is how I would do it if it were up to me, but as I had stated earlier, I would make sure I had the name of the person that advised me from BCBS that they DO NOT coordinate with Benesys.

Good luck
Michele
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kbolt

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Re: Two primary insurances
« Reply #9 on: July 17, 2008, 03:10:31 PM »
Thanks so much for your advice!

jns85008

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Re: Two primary insurances
« Reply #10 on: August 22, 2008, 04:36:09 AM »
I run into this quite often with BCBS, Aetna and Humana. They do not coordinate benefits with several plans or mostly with each other. The pt does get the overpymt amount. We apply both pymts minus the adj from both plans. What's left over gets refunded to the pt. I just wanted to let you know that you are not alone. I hope this helps you out.