Wiki Secondary Insurance - No Patient Responsibility

[Cwebb85]

Can I get some input on this debated topic?

Do you/can you bill secondary insurance when there is no patient responsibilty? My understanding is that yes, you can and you can potentially collect more if the secondary allowable is higher.

For example: You bill $100 to the primary. They allow and pay $70. You bill the secondary. Their allowable is $80. The primary has already paid $70, so $80-$70 =10. The secondary will pay an additional $10.

Can anyone confirm this is correct? If not, why not?

 

[suki_26]

I don't think this is possible that is why payers pay such close attention to the COB ( Coordination of benefits) Usually you have to send the EOB from the primary and that is so the 2ndry can see what is already paid so the bill is not paid over 100%. The 2ndry will ideally pick up what the primary has not... but that is in terms of coinsurance and deductibles. If on the EOB they see the allowed amount was completely paid they don't even look at that line.

What I HAVE seen is a little different and usually an error on the part of the insurance company. I have seen 2 payers both pay as primary. THAT is a totally different situation. Usually in that case you want to let the 2ndry insurance know what they have done and get the COB situation resolved because more times than not they will eventually figure it out and ask for that money back. Its always better to catch that kind of stuff earlier than later. The payers want to pay as little as possible not more than they have to.

 

[csperoni]

This can vary depending the on the patient's contract with the secondary payor. The VAST majority of the time, secondary only covers patient responsibility amounts. Occasionally, a patient may have a contract that requires the secondary to pay the additional amount of their allowable.
While it may not be necessary 99% of the time, it's certainly allowed to bill the secondary as long as you are supplying the correct information about the primary payment.