Wiki Primary and Secondary have different allowed amounts

[kschulte71]

We have a patient that has Aetna Primary. They allowed $109.56 and it was all put to deductible. Patient has BCBS secondary. They processed the claim as Secondary but allowed $140.45. They paid $110.45 with a $30 copay. I am drawing a complete blank on how to handle this. Do we change the contractual adjustment to the BCBS adjustment and bill the patient for the $30 copay?

 

[thomas7331]

If your provider is contracted with both payers, then you have to accept the lower amount as payment in full. In other words, since your contract with Aetna would require that you accept their fee (in this case $109.56) and the secondary payment has fulfilled that obligation, you wouldn't be able to bill the patient for any balance.

 

[vinessachilders]

I ran into this issue before, and I took the time to contact many of the secondary insurance companies to determine what they wanted us to do with the "overpayment". The response across the board was that the contracts we had meant we accepted the amount as payment in full, even if the primary processed a lower amount. They told us to add a negative adjustment (or however your system tracks them) to bring the balance to $0. As for copays, if there is no balance left, no copay can be collected.

 

[location2@curemd.com]

In that case check patient COB with the secondary insurance, it is possible that both insurances is active as primary. I had a similar case and found both are acting as primary. Both claims processed as primary.

 

[sjooemmy08]

In that case check patient COB with the secondary insurance, it is possible that both insurances is active as primary. I had a similar case and found both are acting as primary. Both claims processed as primary.

That is something new I hear. I have had an experience of being in the middle of insurance companies fighting to be secondary, but not primary.