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Duplicate payments from secondary insurance

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We  have a patient with Medicare as primary and 2 secondary insurance policies.  In the last several months both of these secondary carriers have paid the co-ins, leaving the patient with a credit balance.  We do not file these secondary claims, they are electronically crossed over from Medicare otherwise we would not file for additional payment. 

Here's the question.  Do we refund the money to the patient or sent notices to both secondary carriers and let them determine who is secondary and tertiary?  Thanks, Liz

You should make sure both plans are aware of each other.  It is possible that they are paying correctly and the patient is entitled to any overpayments.  Before refunding patient I would recommend contacting both carriers to make sure they realize that the patient has another policy.  If they both are aware and state that they are paying correctly, the patient gets the money.

Usually when both the secondary and tertiary pay as secondary, we call the insurance to see if who is secondary and/or tertiary and see what are the effective dates of coverage for both.  We also look at if the policies are retirement policies and/or if the spouse is the primary on one of the policies and if that spouse is the retiree or working individual. 

I have never refunded the patient the amount that the insurance overpaid.  I usually research and then refund the correct insurance carrier.  The patient is responsible for updating the information with the insurance carrier so we inform the insurance of a possible overpayment and they usually contact the patient by letter asking them to update their insurance information, which some patients ignore.

There are some cases where the patient purchases one of the insurance plans and they are aware of the other policy but they still pay.  It is not common, but it does happen.  That's why I recommended calling both carriers, making sure that they are aware of each other and making sure there is not just an issue with knowing who is tertiary.  There are situations where (although uncommon) where the patient is entitled to the overpayment.  More commonly it is like asilva described and one of the insurance carriers isn't paying properly.  It is important to get to the bottom of it.  In 17 years I have seen a few situations where the patient did need to be sent the money.

Thank you all for your input.  Liz


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