# copays - How much do



## nc_coder (Mar 21, 2013)

Primary ins has $35 copay, secondary has $15.  How much do we collect?


----------



## blakeandtone (Mar 21, 2013)

I would collect $15.00.


----------



## ajb1986 (Apr 19, 2013)

Depends on the benefits, if you are contracted and which CPT code you will be billing. If your contracted with the primary you need to find out what the allowed amount for the CPT code your doctor normally bills and you can collect however much is of that allowed amount is remaining on the deductible. If the primary insurance has met their deductible then you only have to worry about the secondary insurance.

On the secondary you collect based on benefits again. You would need to figure out what percentage of the the primary insurance they will pay. then calculate it off of what CPT code you bill and the allowed amount are. Whatever percentage of the allowed amount that the 2ndary wont cover thats what you collect.


----------



## btadlock1 (Apr 21, 2013)

nc_coder said:


> Primary ins has $35 copay, secondary has $15.  How much do we collect?



It also depends on the allowables - you have to honor both. For example, say you charge $75 for something: Primary allows $65, applies $35 to copay, and makes a payment of $30. But, Secondary only allows $30 for the same charge (we see stuff like this a lot, when the patient has Medicaid secondary - TX Medicaid's reimbursement sucks...). Dependiing on how benefits are coordinated, the secondary EOB may or may not reflect the primary payment - regardless,  since primary paid $30, and that's all that's allowed by secondary, you'd write the remainder off, as a contractual adjustment. The patient wouldn't pay anything...That's just an example, though.


----------



## cirigliano (Apr 21, 2013)

nc_coder said:


> Primary ins has $35 copay, secondary has $15.  How much do we collect?



Hi you wouldn't collecto co-pay patient has 2 insurances.


----------



## cirigliano (Apr 21, 2013)

nc_coder said:


> Primary ins has $35 copay, secondary has $15.  How much do we collect?



Hi you wouldn't collectco-pay patient has 2 insurances.


----------



## btadlock1 (Apr 21, 2013)

cirigliano said:


> Hi you wouldn't collectco-pay patient has 2 insurances.



Doubtful. As the other posts have noted, it depends on several factors:
If both payers allow the charge applied to copay, how much each payer allows, and how much each payer pays. 

If anything, you might collect the secondary copayment amount, but the best bet, is to wait until the claim processes by both, and bill the patient any outstanding amount, when they're double-covered. If you don't honor both plans' allowables, you'll be violating one of your contracts.


----------



## airart (Apr 21, 2013)

*Copayments*

If the secondary payer is a federal plan (ie. Medicare, Medicaid, etc.) then I would not collect anything until after both payers have sent you the EOPs (EOBs.)  

If the secondary payer is commercial (Aetna, BCBS, Cigna, UHC, etc) then I would collect the $15 copay if the practice wanted us to taken some kind of payment from the patient in the practice's policy on the day of the visit.  But our practice policy is that if they patient has dual coverage we do not take anything from the patient until both payers have processed the claims and we have recieved the EOBs showing patient responsibility.  Then we bill the patient if they owe anything. 

If they are lucky enough to have a 100% allowable coordination plan then the seconday will pay the patient responsiblity from the primary plan.  If they have the "other coordination plan" (was at one time called maintenance of benefits), that has changed names more than I can keep up with, then they will be responsible for at least the $15 copay.


----------



## seanny (Apr 23, 2013)

The secondary will likely cover the primary copay...


----------



## beckycmbs (May 7, 2013)

You would collect $15.00


----------

