Author Topic: Two insurance plans in Ohio  (Read 1693 times)

dick43

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Two insurance plans in Ohio
« on: February 02, 2010, 08:47:41 AM »
I received a CT scan and I am covered by two insurance plans. The total amount charged by the facility was $1440.50.
The primary insurance allowable amount was 1224.43, due to network discount. My deductible was 99.03 and coinsurance was 225.08. Payment made by the insurance was 900.32.

The secondary insurance allowable amount was 1065.97, due to a different networks' discount. The facility is a member of both networks. I had no deductible to fulfill on this plan and my copay was 155.85.
This plan made payment of 165.65.
So total insurance payments made was 1065.97, which is the total allowable amount for the secondary insurances network provision.

The facility has sent me a bill for 155.85, the secondarys plan coinsurance. Am I responsible for this?

Michele

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Re: Two insurance plans in Ohio
« Reply #1 on: February 02, 2010, 08:05:25 PM »
I would call the billing office and ask them for an explanation as to how they came to your responsibility.
 

2nd plan allowed:  1065.97
1st plan pd:           900.32
2nd plan pd:          165.65

But yet the 2nd plan indicated pt responsibility of $155.85. I would definitely ask for an explanation.

Michele
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Pay_My_Claims

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Re: Two insurance plans in Ohio
« Reply #2 on: February 02, 2010, 08:18:44 PM »
Its correct from my calculations....

They billed out 1440.50
Your primary allowed 1224.43, but they only paid 900.32 which left 324.11 (deductible & coinsurance)
The balance of 324.11 goes to the secondary.

They only allow 1065.97 they look at what the primary paid 900.32 and subtract what they paid from what they allowed 1065.97-900.32, which leaves 165.65 which would be your balance. You have a deductible/coinsurance from your primary.  if you had no secondary you would have to pay 324.11, but your secondary paid up to what they allowed. it doesn't mean you don't have to pay anything just because you don't have a deductible on your 2ndary plan. They are actually 9.80 off.

Michele

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Re: Two insurance plans in Ohio
« Reply #3 on: February 04, 2010, 05:57:36 AM »
I think that is what is throwing me.  I thought the same thing but when I did the math, it wasn't the same.  That's why I would ask them for an explanation.  I like things to add up!  I guess I'm a little obsessive compulsive when it comes to that.

Michele
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Pay_My_Claims

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Re: Two insurance plans in Ohio
« Reply #4 on: February 04, 2010, 02:05:25 PM »
or they did a typo...which is very likely!!

DMK

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Re: Two insurance plans in Ohio
« Reply #5 on: February 04, 2010, 04:10:33 PM »
If the provider is PAR with both the primary and secondary doesn't he have to agree to accept the lower allowed amount?  Then the patient wouldn't owe anything?

Pay_My_Claims

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Re: Two insurance plans in Ohio
« Reply #6 on: February 04, 2010, 07:39:30 PM »
If the provider is PAR with both the primary and secondary doesn't he have to agree to accept the lower allowed amount?  Then the patient wouldn't owe anything?

no