Wiki Two policies paying as primary

[Gator]

What does your facility do in situations where two different policies both pay as prime resulting in credits? The member states they updated COB multiple times yet, each plan still shows they are prime. Neither insurance company will take money back because they believe they processed correctly as prime. The patient is no longer being helpful in getting COB corrected. As you know, the patient is the only one that can correct COB.

 

[lisaray]

I would keep pushing to get an answer as to which is primary and put it back on the patient to get sorted out with an answer or find a new provider. Usually there are rules The Birthday rule with children and parents each holding insurance on the child.
Or if the company has more than 100 employees then Medicare is secondary
Caution: One of our patients had a very unfortunate experience in which they were told incorrectly that one BCBS policy was primary and the other BCBS was secondary 4-5 years Later the insurance companies discover the mistake and recouped on all payments for the past 4 years from all of her providers. I had to work like crazy to get our claims reprocessed and repaid. Some of her providers sent her to collections and refused to see her any longer. It was not even the patient's or her husband's fault. It was confusing because her spouse had retired from City government and then took job with Teamsters Union. They told them the City insurance would be primary because he had possessed it longer BUT it was retiree policy and the other was a current job.
Huge mess and both policies were BCBS It took a year and a half to get all the claims reprocessed
We spend an enormous amount of time in our practice on denied claims for failure to COB We just send patient a statement stating that they will be financially liable if they do not take care of it and a letter that we will be happy to help them if they don't understand