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Secondary billing and Copay/Deductible Collection

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MacCG:
The primary insurance paid $0.00 of $150.00 and went to deductible leaving $95.23 patient responsibility.   Billed secondary (Tricare) and paid $22.80.   The cost-share responsibility is $46.00.  I'm unsure what to bill the client for since the deductible has not been met from primary. 
 
Also once deductible is met by primary do I collect the primary insurance copay amount or secondary?  The primary insurance copay is less or do I collect a copay at all.


I'm new to primary and secondary billing so any help would be greatly appreciated. 

Thank you! :)



 

kristin:
In order to answer your first question, are you contracted with Tricare? If so, you need to go by what they say is patient responsibility.

For the second question, when a patient has a copay with their primary, but they also have a secondary insurance, I do not collect the copay at TOS. I wait for the claim to process through both insurances first to see what sort of balance is left, if any.

Michele:
Also, if the primary applied to a deductible then there wouldn't be a copay with the primary. 

Like Kristin said, if a patient has two insurances it is best not to collect until both insurances have paid, and then you go by what the insurance says is the patient responsibility.

Hopefully this helps!

MacCG:
The Primary is BCBS and secondary is Tricare in which we are both contracted.   Since the primary went to deductible (no copay just deductible due) and secondary is showing the cost share amount (client's responsibility) which amount would be the appropriate to ask of client?  Also after the deductible is once met with primary insurance do I collect the primary insurance copay or the secondary.  Just unclear on which one to collect.   


I appreciate your help! :)

Michele:
In answer to the second part of the question, I wouldn't collect any copay until both insurance pay.  TRICARE may pick up the copay of the primary, so you really don't know until they make payment.

In answer to the first part of the question, there are a lot of different opinions on this, but here we believe that you have to accept the amount that TRICARE states.  If you charge the patient the amount BCBS indicated you will be breaking your contract with TRICARE.

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