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Pediatric Coding Alert

Reader Question:

Know How to Handle Deductible Balance

Published on Tue Jul 31, 2012

Question: Our patient has two insurers--Payer A is the primary and Payer B is the secondary. We performed a procedure and Payer A paid $120. The claim then went to Payer B for the balance of $50.00, but that whole amount went to the patient's deductible, so that $50.00 is still owed to us for this claim. Is the patient responsible for paying us this $50.00? California Subscriber Answer: It's hard to say for sure whether the patient can be billed without additional details, but in general, a few variables can come into play in this type of scenario. Although we don't know the specifics of your case, we'll assume three truths: (1) The doctor has no contract with Payer A or Payer B, (2) The plans are not Medicaid plans, and (3) These are not HMO Plans under a state no balance billing HMO law. In addition, we aren't sure [...]
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