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pweinstein:
Can anyone give me an answer to this one?
When a patient has a comp case that is only 50% covered by workers comp and the rest of the claim is 50% covered by say INDEPENDENT HEALTH INS. Does the insurance company (Independent Health) pay at their contracted rate at 50% or the 50% of the comp rate? I am billing in New York if that makes a difference.
Michele:
We are in NY as well and have had a few of these cases. The workers' comp claim is submitted first, then you submit to the secondary with a copy of the comp eob. The secondary, or major medical insurance carrier pays on the 50% of the comp fees, not on their own fee schedule.
Michele
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