Wiki Allowable amounts for primary and secondary

[busterbrown2940]

Hi, I am hoping somebody can help with this scenario and also provide somewhere were I can find the proper documentation to support the decision:

Patient has commercial insurance A as primary, commercial insurance B as secondary. Provider is in network with both A and B.

Insurance A shows an allowable amount of $65, pays $55, patient responsibility is $10.
Insurance B shows an allowable amount of $100, pays $0 (applies to deductible), patient responsibility is $100.

Is provider supposed to bill the patient for the $10 per Insurance A patient responsibility,
or $100-$55 paid by insurance A=$45 per Insurance B.

Any help would be appreciated - as well as where I can find the documentation regarding this.

Thank you,

Susan Wood, CPC-A, CPB

 

[Jessim929]

You might want to check on coordination of benefits - it almost sounds like Insurance B processed as if they were primary. That could lead to issues down the road.

Otherwise, my experience has been that you only bill the patient the $10.

 

[busterbrown2940]

You might want to check on coordination of benefits - it almost sounds like Insurance B processed as if they were primary. That could lead to issues down the road.

Otherwise, my experience has been that you only bill the patient the $10.

Insurance B shows it did process as secondary.