Wiki Medicare PRIMARY (wrong benefits)

[LuluBarr]

One of our billers sent a claim to our PT's secondary insurance because they didn't have Part B benefits (we're in a doctors office), but now the secondary is asking for a refund of previous payments because the PT has medicare primary.

If a patient has medicare primary but has no Part B Medicare benefits should a doctors office bill medicare first anyway, and then the secondary?

 

[Walker22]

We have run into this on one of patients that had Cigna secondary. We went around and around with them, and finally we just started billing to Medicare first and sending a copy of the denial to Cigna with the secondary claim.

 

[Jfrank]

We have this same issue with a few of our pt's. We always bill medicare first then the secondary, they need the e.o.b. to determine their portion of the claim. Since the pt is eligible for part B, but elects not to have
it, the secondary is only going to pay as a secondary, and the rest of the balance is the pt's responsibility.
If your secondary paid as primary, thinking they were the only ins, this is why they want their money back. Even though the pt has no part B, the secondary is going to process the claim as if they do.