Author Topic: 3 Insurances  (Read 5317 times)

ellie

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3 Insurances
« on: February 05, 2011, 12:58:58 PM »
Hello,

I have a patient who has Medicare primary, Medicaid secondary and Mutual of Omaha. Medicare and Medicaid paid leaving a zero balance. Mutual of Omaha paid out as secondary ? What do I do with this credit ?
Thank you

PMRNC

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Re: 3 Insurances
« Reply #1 on: February 05, 2011, 01:05:44 PM »
If the Mutual of Omaha plan is a private, non contributory plan, you would give the credit to the patient. They are over insured. The reason you give it to them is because they are paying for the premium's. Though it would seem they are gaining financially with that credit, they are not, they are paying more in premium's than needed.
Linda Walker
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rofakamd

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Re: 3 Insurances
« Reply #2 on: March 11, 2011, 09:09:18 AM »
re 3 insurances... medicaid is always payor of last resort ins listed shb  medicare mutual of omaha then medicaid....

PMRNC

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Re: 3 Insurances
« Reply #3 on: March 11, 2011, 09:21:31 AM »
Quote
re 3 insurances... medicaid is always payor of last resort ins listed shb  medicare mutual of omaha then medicaid....

That's not necessarily true. IF that plan is a private (non contrib plan) their payment could be a credit. ALTHOUGH I sure would look into their eligibility for Medicaid by contacting Medicaid with the Omaha Mutual plan information.
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tlewis

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Re: 3 Insurances
« Reply #4 on: March 15, 2011, 06:29:22 PM »
I"m going to go out on a limb here and say that medicaid does not know about mutual of omaha. Mutual of omaha is a VERY common medicare supplement plan. I would call your medicaid office and ask if they show the patient as having Mutual of Omaha. Then give the information that you have for that insurance. If not and medicaid pays then finds out later that the patient has mutual of omaha they are going to want their money back and by then you prob won't be able to rebill mutual of omaha. Biller friend  is having this prob right now. Medicaid came back 3 yrs later stating that the patient had a primary on DOS wants their money back and it's to late to bill the primary now. She has a copy of the eligibilty page from medicaid that you are suppose to look up everytime you see a medicaid patient  that does not show a primary, but they are still going to want their money back, She will prob be able to bill the patient but I highly doubt she will ever see any money for this.

rdmoore2003

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Re: 3 Insurances
« Reply #5 on: April 20, 2011, 08:33:51 AM »
My software does not hold 3 insurances.  I now have patient that has medicare and 2 different bc plans.  If my system is not made to hold 3 insurances, what should I do in this case?
Regina

Anand

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Re: 3 Insurances
« Reply #6 on: April 20, 2011, 08:43:54 AM »
I think you have few choices,

-> You may talk to your software vendor and see if they could do anything or give you some tip to add this - based on the outcome you may decide

(or)

-> Somewhere in the DB put a pop-up message stating pt has two BC policies - so once secondary paid and bal got to be billed to tertiary. So while posting payments/working on that account everyone aware of the situation.

If someone has any better opinion, i would like to know. Thanks

Michele

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Re: 3 Insurances
« Reply #7 on: April 21, 2011, 07:40:10 AM »
What software are you using?  I haven't seen one that only allowed 2 insurances before.
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DMK

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Re: 3 Insurances
« Reply #8 on: April 21, 2011, 10:17:15 AM »
I use Forte's Chiro 7000 and it only allows primary and secondary insurance.

Michele

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Re: 3 Insurances
« Reply #9 on: April 22, 2011, 07:51:09 AM »
I haven't heard of that.  Wow, you learn something new every day!  Unfortunately you are going to have to find a way to flag it and then manually change the secondary info to the tertiary once the secondary payment is received so that you can bill out the tertiary.  Fortunately this isn't too common!
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PMRNC

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Re: 3 Insurances
« Reply #10 on: April 23, 2011, 09:29:32 PM »
Wow, I'm thinking that software is going to need to have tertiary options..especially in the VERY near future!
Linda Walker
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rdmoore2003

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Re: 3 Insurances
« Reply #11 on: April 26, 2011, 10:25:49 AM »
I use Office Therapy.
Regina

suky12

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Re: 3 Insurances
« Reply #12 on: July 28, 2011, 03:58:19 PM »
If the Mutual of Omaha plan is a private, non contributory plan, you would give the credit to the patient. They are over insured. The reason you give it to them is because they are paying for the premium's. Though it would seem they are gaining financially with that credit, they are not, they are paying more in premium's than needed.

I was told that we need to refund the third insurance.  But this was a little difference.  Patient have Medicare and the other two are private insurance.  I would think you should refund the patient because they are paying on the premiums, right?  I argued, but was told it's not correct.  Now, I am second guessing myself.  ???

PMRNC

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Re: 3 Insurances
« Reply #13 on: July 30, 2011, 12:05:05 PM »
Who is telling you to reimburse the carrier? Don't bother they will just turn around and send it back. The patient is obviously over insured, it might LOOK like they are getting more for that one visit but when you add up their premium's they are actually getting ripped off. It happens, unfortunately to a lot of senior's, these private plan's send out agent's who offer up free lunches and breakfasts and get patient's to sign up.  Send the patient a check with a statement. 
Linda Walker
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