Author Topic: secondary billing  (Read 1888 times)

windy miller

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secondary billing
« on: March 21, 2010, 11:21:37 PM »
Hi,
 I'm in a medical billing class on line and I need some help with secondary billing: I have a question about a claim that the patient has paid the bill in full of 120.00  and the first claim has paid 65.25 and it says that the claim was paid on behalf of the insurance company of what they allowed, does that mean that the secondary insurance gets filled or not? Please help.....
    Thank you,
      Windy

Anand

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Re: secondary billing
« Reply #1 on: March 22, 2010, 03:22:47 AM »
Hi,

  Yes as along the insurance pay what they allow normally there wont be any pt's resp. Its understood that they pay 100% of what they allow. After primary ins paid & no pt resp - I dont see any need of flipping the balance towards secondary, further I would refund the money back to the pt as well. Thanks

 
   

Michele

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Re: secondary billing
« Reply #2 on: March 22, 2010, 07:04:22 AM »
The secondary should be billed anyway.  If the secondary allows a higher amount then they will make payment based on their allowance.

Michele
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Pay_My_Claims

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Re: secondary billing
« Reply #3 on: March 22, 2010, 07:08:17 AM »
Hi,

  Yes as along the insurance pay what they allow normally there wont be any pt's resp. Its understood that they pay 100% of what they allow. After primary ins paid & no pt resp - I dont see any need of flipping the balance towards secondary, further I would refund the money back to the pt as well. Thanks

 
   

You can't ASSume that. part of the balance may have dropped to patient's deductible and therefore is the patients responsibility. The md may be out of network with the insurance, who's to say what the scenario is. but what we do know is that if the client paid up front, the MD does owe the client at least what the primary paid. The rest would vary depending on other situations

Anand

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Re: secondary billing
« Reply #4 on: March 22, 2010, 08:47:42 AM »
The secondary should be billed anyway.  If the secondary allows a higher amount then they will make payment based on their allowance.

Michele

Michele- Thanks, sorry that I have responded wrongly. But i have question for you based on your explanation

Let's say Primary is Aetna - They a/a $150.00, paid $150.00 with no pt resp. Dr is Par. C/A - 50
Pt has Humana - do you still Bill Humana with Aetna's EOB to find out if thier allowed amount is more than what Aetna is Allowed..I dont know if it sound basic.. but i just need clarity on this.. Thanks

Anand

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Re: secondary billing
« Reply #5 on: March 22, 2010, 08:53:55 AM »
Hi,

  Yes as along the insurance pay what they allow normally there wont be any pt's resp. Its understood that they pay 100% of what they allow. After primary ins paid & no pt resp - I dont see any need of flipping the balance towards secondary, further I would refund the money back to the pt as well. Thanks

 
   

You can't ASSume that. part of the balance may have dropped to patient's deductible and therefore is the patients responsibility. The md may be out of network with the insurance, who's to say what the scenario is. but what we do know is that if the client paid up front, the MD does owe the client at least what the primary paid. The rest would vary depending on other situations..


Charlene- I have read your post's infact many a times - it helps me.. thanks for this one too.. :)

windy miller

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Re: secondary billing
« Reply #6 on: March 22, 2010, 09:54:06 PM »
Hi,
 I'm working on this secondary billing claim from an on-line course and have questions. Here goes. A patient has insurance at her work and also covered with her husband's insurance. She (the patient) paid the bill in full at time of services. Her insurance company was charged $120.00 for the services, insurance did not cover $37.50, the insurance allowed $82.50, the patients deductible was $10.00, coinsurance was $7.25, benefit amount was $65.25.

 EOB deductible summary as follows:

with this payment, total deductible amount for Sally    $100.00
for the year has been settled                               

with this payment, total deductible amount for the      $300.00
Smith family for the year has been met.

Patient Summary:

Total benefit amount for all claims submitted:             $65.25


This claim was paid on behalf of Blue Cross of IA.


 My question is: Do I file a secondary claim or not?
    Thank you for all your help.

     Windy Miller

DMK

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Re: secondary billing
« Reply #7 on: March 23, 2010, 10:58:16 AM »
Yes, you file the secondary claim.  They may have a higher allowed amount than the primary, and they could at the very least pick up the deductible and the co-pay (unless there is a deductible on the secondary).  At this point, the patient is owed $102.75.  She may well get all of her money back.  (In California, providers must refund overpayments in 30 days).

The main thing is that the patient has 2 insurances and they both should be billed so that the patient gets ALL of the benefits she's entitled to.

Michele

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Re: secondary billing
« Reply #8 on: March 24, 2010, 06:42:06 AM »
"Let's say Primary is Aetna - They a/a $150.00, paid $150.00 with no pt resp. Dr is Par. C/A - 50
Pt has Humana - do you still Bill Humana with Aetna's EOB to find out if thier allowed amount is more than what Aetna is Allowed..I dont know if it sound basic.. but i just need clarity on this.. Thanks"



I would because if the dr is par with Humana, and Humana allows a higher amount, they may pay additional.

Michele
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