Billing > Billing
secondary billing
Anand:
--- Quote from: Pay_My_Claims on March 22, 2010, 10:08:17 AM ---
--- 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..
--- End quote ---
Charlene- I have read your post's infact many a times - it helps me.. thanks for this one too.. :)
windy miller:
Hi,
I'm working on this secondary billing claim from an on-line course and have questions. Here goes. A patient has insurance at her work and also covered with her husband's insurance. She (the patient) paid the bill in full at time of services. Her insurance company was charged $120.00 for the services, insurance did not cover $37.50, the insurance allowed $82.50, the patients deductible was $10.00, coinsurance was $7.25, benefit amount was $65.25.
EOB deductible summary as follows:
with this payment, total deductible amount for Sally $100.00
for the year has been settled
with this payment, total deductible amount for the $300.00
Smith family for the year has been met.
Patient Summary:
Total benefit amount for all claims submitted: $65.25
This claim was paid on behalf of Blue Cross of IA.
My question is: Do I file a secondary claim or not?
Thank you for all your help.
Windy Miller
DMK:
Yes, you file the secondary claim. They may have a higher allowed amount than the primary, and they could at the very least pick up the deductible and the co-pay (unless there is a deductible on the secondary). At this point, the patient is owed $102.75. She may well get all of her money back. (In California, providers must refund overpayments in 30 days).
The main thing is that the patient has 2 insurances and they both should be billed so that the patient gets ALL of the benefits she's entitled to.
Michele:
"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"
I would because if the dr is par with Humana, and Humana allows a higher amount, they may pay additional.
Michele
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