Payments > Patient Billing

which allowable???

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dekenn:
This doesn't happen often, but I'm confused about what the patient balance would be:
We participate with both primary and secondary insurances:
Primary insurance allows $30, pays $25. with $5.00 patient copay (which was collected)
Secondary insurance allows $44.67, shows primary payment of $25, and patient liability of $19.67 (44.67 - 25.00)

So, is the patient only responsible for the primary copay of $5, or the additional $14.67 allowed by the secondary???   ??? ???

PMRNC:
Bare with me as I am not done with my first cup of coffee...You would take the carrier with the highest allowable and their coinsurance would apply, so I am guessing you would need to collect another $14.67   (19.67 - $5 copay paid)  For some reason my brain however is saying I should ask for the original charge.

rdmoore2003:
wouldnt you only bill secondary for the copay?

dekenn:
the same claim, with the same charges goes to the secondary, it's just marked as "secondary" and
has the primary eob attached

PMRNC:

--- Quote ---wouldn't you only bill secondary for the copay?
--- End quote ---

No, you always bill the secondary. There are even secondary plans that are individual plans to which it might even seem the patient is getting more money, that's because they pay an individual premium for the plan. (ie; over insured)

COB rules say you take the higher allowable in determining the adjustment write off/OOP

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