Wiki Primary and Secondary insurance, bill patient the difference?

[JesseL]

I have a situation here.
Example:
Patient's PRimary: Allows $300 but applied to deductible.
Patient's Secondary: Allows and pays $100
This leaves a balance of $200

We are in-network with both insurances.

In this case, do we bill the patient the difference of $200 or write off the $200.

Our allowed rate is higher than the secondary, who's fee schedule contract do we have to follow?

 

[JRalston]

Primary/Secondary Billing

If your physician is contracted with both payers, you would write off the remaining $200 as per the contract with the secondary carrier.

Jennifer Ralston, RHIT, CPC

 

[JesseL]

So in this case we ignore our contract with the primary payer?

 

[ftorres]

Yes, its not really ignoring the contract with first payer, its honoring the contract with the second payer as well. Say primary payer allowed 300 and paid 200, only 100 went to deductible. If secondary payer allows 100, it would not have paid any additional payment. You would not bill the patient anything in that case either because you are honoring both contracts.

 

[KN]

By law if you participate with both insurers you cannot bill the member anything other than what is their patient responsibility, that's what your provider agreed to when they participate with insurance. The "$200" is the adjustment you agreed upon per the contract. You have to be extremely careful with patient balance billing, as you can get your provider cancelled from his contracts and if Medicare/Medicaid even more problems with greater consequences. Your provider can always try to renegotiate his fee schedule and his contract terms.