Pathology/Lab Coding Alert

Question: Often, when we perform lab tests, the patient has secondary insurance, some of which have deductibles on the secondary. In these cases, should we write off the amount of the deductible because it's secondary, or do we bill the patient?

Ohio Subscriber

Answer: Labs may bill the secondary insurance on behalf of patients, but if the patient has a deductible on the secondary insurance, you can and should bill the patient that amount. Your physician clients should pass on the patient insurance information to you. You will need to verify which insurance is primary, so you can bill that payer first. Once you get the EOB from the primary payer, send your claim to the secondary, with a copy of the primary's EOB attached.

In most cases, after you've received both payments, you'll take the adjustments from whichever insurance has the larger adjustment. You should not take adjustments from both plans, nor should you write off deductibles. You'll bill the patient for any remaining balance that is his or her responsibility once you have both payments. Of course, individual payer contracts reign when determining where to collect.

Hint: Some secondary insurers pay the primary's co-pay (including Medicaid as the secondary insurer), but many do not.