Author Topic: pt. with 2 insurances  (Read 2195 times)

Buglet10

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pt. with 2 insurances
« on: August 26, 2011, 08:26:33 AM »
A client has Medicare as primary and UBH as secondary.  Medicare allowed is $157.00 and they paid $100.00(not exact but fine for this question).   UBH only allows $65.00 so they made no payment as secondary insurance as Medicare paid over what they allow.  Now is the client responsible for the other $57.00 not paid or do we need to write off the $57.00 as it is over what UBH allows?  I always find it hard when the 2nd insurance allows under what Medicare allows.  I'm never sure how much we can charge the patient or if we have to write it off. Thanks for your help.

Sriram_Sub

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Re: pt. with 2 insurances
« Reply #1 on: August 26, 2011, 10:16:23 AM »
Hi Buglet,
I believe (not sure though) you need to go by what your EOB says. If an amount has been applied as Patient responsibility, that is what you will be billing your patient for. Else, you would need to write off the balance. Hope this helped. I will wait to see a better advice from others, if available. Thanks.
Sriram

DMK

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Re: pt. with 2 insurances
« Reply #2 on: August 26, 2011, 01:03:51 PM »
If your provider is contracted with Medicare, they have agreed to take the allowed amount.  The Secondary would normally pick up co-pay or deductible UNPAID by Medicare (the write off is the write off).  If Medicare paid more than the Secondary allows, you can not charge the patient the difference.

Buglet10

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Re: pt. with 2 insurances
« Reply #3 on: August 28, 2011, 02:55:12 PM »
Medicare did pay more than what UBH (secondary) allows but not up to what they (Medicare- we are contracted and would never bill more than what Medicare allows) allows.  There is still $57.00 that Medicare allows not paid by UBH.  Not sure if I'm explaining this correctly.  This $57.00 is what I am wondering about.  Thanks for your answers.  If anyone else has any light to shed please do I really appreciate it.
 

DMK

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Re: pt. with 2 insurances
« Reply #4 on: August 29, 2011, 11:09:24 AM »
Medicare would normally only pay 80% of the allowed amount.  The secondary would usually pick up that 20% OR would apply it to the secondary co-pay or deductible.  HOWEVER, if the secondary's allowed amount is less than the 80% paid by Medicare you still can NOT charge the patient for the difference.

Example:

Bill amount     $100
Medicare allows $80.00 and pays their 80% $64.00
Secondary allows $60 for the same service.
Medicare already paid more than the secondary allows.  You CAN NOT bill the patient the unpaid $36.00.  It's a write off.


Buglet10

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Re: pt. with 2 insurances
« Reply #5 on: August 29, 2011, 12:07:36 PM »
Excellent that is exactly what I was wondering and also what I've been doing so I'm glad to know it was correct.  Thanks so much.       

asilva03

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Re: pt. with 2 insurances
« Reply #6 on: August 30, 2011, 09:10:22 PM »
Be careful because you will only adjust if you participate with the secondary payer.  If you do not participate then you are not obligated to write off the secondary amount just because medicare allowed more.

dygebbs

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Re: pt. with 2 insurances
« Reply #7 on: September 06, 2011, 03:04:10 PM »
Hey check UBH EOB if it is states patient responsibility then balance can be billed to patient as some insurances will apply towards out of pocket expense.

Buglet10

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Re: pt. with 2 insurances
« Reply #8 on: September 06, 2011, 07:26:50 PM »
Thanks everyone I'll check the eobs.