Payments > Patient Billing

Primary and secondary ins allowance

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dekenn:
What if they have a medicaid hmo as their secondary? And the medicaid hmo won't pay because primary payment is over their allowable. For instance, Primary is aetna, with a $20.00 copay. Aetna pays $48.54 and patient responsibility is the copay. Send to secondary (whose normal allowable is $44.00), they pay nothing.
Can we bill the patient the copay?
THanks

Merry:
No, unless the patient has a share of cost. But here is a question. Are you contracted with that particular Medicaid HMO?

PMRNC:

--- Quote ---What if they have a medicaid hmo as their secondary? And the medicaid hmo won't pay because primary payment is over their allowable. For instance, Primary is aetna, with a $20.00 copay. Aetna pays $48.54 and patient responsibility is the copay. Send to secondary (whose normal allowable is $44.00), they pay nothing.
Can we bill the patient the copay?
THanks
--- End quote ---

As Merry mentioned it will be a factor if you are participating with that particular Medicaid/Plan (HMO). Simply being a Medicaid provider (depending on your state) wouldn't matter, it would be that particular HMO plan. In that case NO.. you can't bill the patient for anything as they would have HAD to go to an in-network provider to receive benefits.

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