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secondary billing

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windy miller:
Hi,
 I'm in a medical billing class on line and I need some help with secondary billing: I have a question about a claim that the patient has paid the bill in full of 120.00  and the first claim has paid 65.25 and it says that the claim was paid on behalf of the insurance company of what they allowed, does that mean that the secondary insurance gets filled or not? Please help.....
    Thank you,
      Windy

Anand:
Hi,

  Yes as along the insurance pay what they allow normally there wont be any pt's resp. Its understood that they pay 100% of what they allow. After primary ins paid & no pt resp - I dont see any need of flipping the balance towards secondary, further I would refund the money back to the pt as well. Thanks

 
   

Michele:
The secondary should be billed anyway.  If the secondary allows a higher amount then they will make payment based on their allowance.

Michele

Pay_My_Claims:

--- Quote from: Anand on March 22, 2010, 06:22:47 AM ---Hi,

  Yes as along the insurance pay what they allow normally there wont be any pt's resp. Its understood that they pay 100% of what they allow. After primary ins paid & no pt resp - I dont see any need of flipping the balance towards secondary, further I would refund the money back to the pt as well. Thanks

 
   

--- End quote ---

You can't ASSume that. part of the balance may have dropped to patient's deductible and therefore is the patients responsibility. The md may be out of network with the insurance, who's to say what the scenario is. but what we do know is that if the client paid up front, the MD does owe the client at least what the primary paid. The rest would vary depending on other situations

Anand:

--- Quote from: Michele on March 22, 2010, 10:04:22 AM ---The secondary should be billed anyway.  If the secondary allows a higher amount then they will make payment based on their allowance.

Michele


--- End quote ---
Michele- Thanks, sorry that I have responded wrongly. But i have question for you based on your explanation

Let's say Primary is Aetna - They a/a $150.00, paid $150.00 with no pt resp. Dr is Par. C/A - 50
Pt has Humana - do you still Bill Humana with Aetna's EOB to find out if thier allowed amount is more than what Aetna is Allowed..I dont know if it sound basic.. but i just need clarity on this.. Thanks

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