Payments > Insurance Payments
pt. with 2 insurances
Buglet10:
A client has Medicare as primary and UBH as secondary. Medicare allowed is $157.00 and they paid $100.00(not exact but fine for this question). UBH only allows $65.00 so they made no payment as secondary insurance as Medicare paid over what they allow. Now is the client responsible for the other $57.00 not paid or do we need to write off the $57.00 as it is over what UBH allows? I always find it hard when the 2nd insurance allows under what Medicare allows. I'm never sure how much we can charge the patient or if we have to write it off. Thanks for your help.
Sriram_Sub:
Hi Buglet,
I believe (not sure though) you need to go by what your EOB says. If an amount has been applied as Patient responsibility, that is what you will be billing your patient for. Else, you would need to write off the balance. Hope this helped. I will wait to see a better advice from others, if available. Thanks.
DMK:
If your provider is contracted with Medicare, they have agreed to take the allowed amount. The Secondary would normally pick up co-pay or deductible UNPAID by Medicare (the write off is the write off). If Medicare paid more than the Secondary allows, you can not charge the patient the difference.
Buglet10:
Medicare did pay more than what UBH (secondary) allows but not up to what they (Medicare- we are contracted and would never bill more than what Medicare allows) allows. There is still $57.00 that Medicare allows not paid by UBH. Not sure if I'm explaining this correctly. This $57.00 is what I am wondering about. Thanks for your answers. If anyone else has any light to shed please do I really appreciate it.
DMK:
Medicare would normally only pay 80% of the allowed amount. The secondary would usually pick up that 20% OR would apply it to the secondary co-pay or deductible. HOWEVER, if the secondary's allowed amount is less than the 80% paid by Medicare you still can NOT charge the patient for the difference.
Example:
Bill amount $100
Medicare allows $80.00 and pays their 80% $64.00
Secondary allows $60 for the same service.
Medicare already paid more than the secondary allows. You CAN NOT bill the patient the unpaid $36.00. It's a write off.
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