Author Topic: HELP PLEASE! Primary/Secondary and Patient Responsibility  (Read 276 times)

PMRNC

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Re: HELP PLEASE! Primary/Secondary and Patient Responsibility
« Reply #15 on: October 16, 2017, 08:45:04 PM »
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This is a great topic.  It isn't something that comes up terribly often but when it does it is always a debate.  I know it goes by COB method but I'm still hung up on the fact that the secondary is saying $0 PR.

Well, the secondary paid $35... so yes I'm also hung up on on the $0 responsibility with secondary.   It would help tremendously if we had a full break down of charges and both primary / secondary allowable, payments.



Linda Walker
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Chiro Billing Collect

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Re: HELP PLEASE! Primary/Secondary and Patient Responsibility
« Reply #16 on: October 17, 2017, 08:23:40 AM »
Yes,  Exactly! That is probably the first thing the patient will point out if billed $10 per visit. (There are multiple visits with this scenario).

PMRNC

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Re: HELP PLEASE! Primary/Secondary and Patient Responsibility
« Reply #17 on: October 17, 2017, 08:45:07 AM »
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Total charges $110: BCBS (primary): Allowable $45 (went towards deductible) - Patient Responsibility $85 - Paid $0
 1199-Aetna (secondary): Allowable $35 - Patient Responsibility $0 - Paid $35

I slept on this one, and after few cups coffee. In one of the posts I think you said the patient's plan only allowed $45  you were adjusting off the $40 spinal charge..why is that? Just because the carrier didn't allow it doesn't mean you cannot bill the patient. That is why they show $85 as PR, then secondary comes into play and they pay $35. Can you break down the secondary EOB for me a bit better with each charge, secondary allowable per charge and any remarks on the EOB? The patient should STILL have to meet cost-sharing with the primary (you said secondary $0 copay $0 ded) and secondary paid $35 BUT the carrier is making patient responsible for the other $40 so you shouldn't have to write that off. The secondary didn't allow it all so need to know WHY? The way I calculate this patient owes $50 because of the $85 the primary says is owed, the secondary paid $35 of it making patient have to pay $50 

I think what is confusing you might be that you think all $0 allowable is a par adjustment and that's not so. The adjustment is the difference between the billed charge and the allowable amount due to the contractual discount. A zero allowable could be a "non" covered service which is why I'd like to see the secondary's breakdown and any remarks on it. Without the secondary plan the patient is responsible for $85 ($45 which was allowable they put towards deductible and the other $40 is "non covered" under patient plan) 

This might be an error on secondary plan's part. If you want to de-identify both EOB's and send to me I'll take a look if you want. Otherwise just post the breakdown of the secondary along with any remarks on the EOB that might explain why they say PR = $0  my email is linda@billerswebsite.com
« Last Edit: October 17, 2017, 08:47:03 AM by PMRNC »
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com