Author Topic: primary & secondary insurances  (Read 1433 times)

ellie

  • Jr. Member
  • **
  • Posts: 87
primary & secondary insurances
« on: June 10, 2010, 08:51:39 PM »
total billed  1250.00
insurance payment from primary carrier  336.00
contractual adjustment  830.00
pt coinsurance transfer to secondary carrier 84.00

secondary payment 422.00
contractual adjustment 722.50
pt coinsurance due for secondary carrier is  $ 105.50

now there is a credit with the secondary payment. what does the patient actually owe or credit do they get or none  ??  

don't get many of these at all.

thanks for the help
« Last Edit: June 10, 2010, 09:12:10 PM by ellie »

blhoffman

  • Full Member
  • ***
  • Posts: 112
Re: primary & secondary insurances
« Reply #1 on: June 11, 2010, 03:42:33 PM »
Hi ellie,

When you billed the Secondary - either CMS or UB - did you put in Primary payment received and, as well as submitting the Primary EOB. Sometimes a Secondary insurance will miss the previous payment and pay out the full allowed amount in error. Happens alot actually.

I would check your claim, make sure you filled out the appropriate dollar amounts received from Primary and make sure EOB was attached, then call the Secondary insurer and have them pull the image of the claim and EOB and reprocess claim.

I had this happen on Monday, then last week, the week before that and so on. The majority of all our billing goes to Secondary and Tertiary. Like I said, I see it alot.  :-\


Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4771
    • Solutions Medical Billing
Re: primary & secondary insurances
« Reply #2 on: June 14, 2010, 12:14:57 PM »
It is possible that the secondary plan is a purchased insurance, and therefore doesn't go by coordination of benefits.  In either case, I would call to make sure it was processed correctly so you don't receive a refund request a year from now, after overpayment has been issued to a patient.

Michele
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

dekenn

  • Jr. Member
  • **
  • Posts: 77
Re: primary & secondary insurances
« Reply #3 on: June 14, 2010, 12:23:55 PM »
Doesn't it depend on whether you're par/non-par, plan pays UCR or contractual amount?  I know it's confusing, but one of the scenarios in my BCBS handbook, shows both insurances paying, as long as the combined payment does not exceed the billed amount.  "Primary plan pays on the basis of UCR and Horizon BCBSNJ pays on the basis of a contractual fee schedule, the primary plan pays its benefits without regard to the other coerage and HOrizon BCBSNJ pays the difference tween billed charges and athe benefits paid by the primary plan up to the amount we would have paid if primary."
Billed:  1250
Primary paid UCR:  336
Horizon fee schedule if primary:  422
Provider would get a total of 758, which is below the billed amount.
It also says that the covered person is only liable for cost sharing under the secondary (BCBS) if she has NO liability for cost sharing under the primary, and total payments of the primary and secondary are less than billed charges.