Author Topic: Retirement plan vs Purchased supplement plan  (Read 1153 times)

plennartz

  • Newbie
  • *
  • Posts: 2
Retirement plan vs Purchased supplement plan
« on: November 04, 2009, 01:41:11 PM »
How do you determine what plan is 2nd vs 3rd.  I have a patient that has Medicare, a retirement supplement plan and a purchased supplemental policy.  How do you determine 2nd or 3rd.  Also if both the retirement plan and the purchased supplement plan boths and now there is a credit on the account how do you determine who gets the refund?

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: Retirement plan vs Purchased supplement plan
« Reply #1 on: November 04, 2009, 02:42:09 PM »
The purchased plan is tertiary and in essence the patient is over insured. This might surprise you but the patient gets the credit on the account assuming all contractual adjustments were taken and out of pocket satisfied. You do not send the refund back to the tertiary carrier because they will just send it to the patient. You might be thinking the patient is making money but they are not.. their premiums are far outweighing the small amounts left on normal visits to the doctor. What I usually do is send the patient the check and include information about being over insured. you can research this and come up with a lot of articles. Many seniors are the targets of a lot of high pressure insurance sales.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

plennartz

  • Newbie
  • *
  • Posts: 2
Re: Retirement plan vs Purchased supplement plan
« Reply #2 on: November 09, 2009, 10:03:05 AM »
Is there any documentation on this rule.  This is what we have always followed as a rule, but I have a retirement plan wanting their money back stating the purchased plan should be secondary.  I have asked them where their documentation is support their refund request.  But they are just zapping the money back from payments.

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: Retirement plan vs Purchased supplement plan
« Reply #3 on: November 10, 2009, 06:21:11 AM »
Again the purchased plan is going to be your last payor. If the retirement supplemental is requesting a refund, call them and make sure they have the Order of COB correctly. Each of those three payors MOST likely have established COB, that would be my first step.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com