Billing > Billing

Referrals when there are two active insurance plans

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Zeecy:
A patient has two active insurance plans.  He is coming to our office, as his PCP, to get a referral for a specialist.  The specialist only takes insurance A.  Our reimbursement is higher with insurance B.  Can I assume we have to bill the visit for the referral to insurance A anyway?  If we bill to insurance B, will insurance A refuse to pay the specialist?

Was that too confusing?

Maybe it's more simple to ask if the referral has to be billed to the same insurance as the specialist visit.

Thanks in advance!

Michele:
You can't pick which insurance you want to bill based on reimbursement, you have to go by which insurance is prime and which is secondary. 

Did I miss something?    ???

Michele

PMRNC:

--- Quote ---The specialist only takes insurance A.  Our reimbursement is higher with insurance B.
--- End quote ---

I'd certainly want to know why that is.. ???
But Michele is right, you have to bill both carriers (par or not) in the order of Coordination of Benefits with the patients primary carrier being first and then submitting the primary EOB to the secondary.

Zeecy:
At he risk of sounding additionally ignorant, what if the specialist doesn't take the patient's primary insurance? 

If the insurance plans are from the patient & from the patient's spouse, is that how I can know which is primary & which is secondary?

Otherwise, how do I know which is primary? 

Help!

Pay_My_Claims:

--- Quote from: Zeecy on June 18, 2009, 05:57:06 PM ---At he risk of sounding additionally ignorant, what if the specialist doesn't take the patient's primary insurance? 

If the insurance plans are from the patient & from the patient's spouse, is that how I can know which is primary & which is secondary?

Otherwise, how do I know which is primary? 

Help!

--- End quote ---

If the specialist doesn't accept the primary insurance, you still have to bill that first. Lets say you have Cigna and UHC. The specialist is OON with Cigna, but the client has OON benefits. You still have to obtain an OON referral and bill as usual. In order for that provider to bill UHC he has to bill that primary first. He can ask the patient to pay up front and bill the claim non assigned. Some providers don't accept secondary plans except for Medicare/Medicaid.

Determining COB is very important you have to know the rules of insurance to do that adequately.

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