Secondary insurance balances

[SANEAST]

Primary allows and applies 77.59 to deductible w/o is 82.41

secondary allows 63.74, pays 43.74 w/ 20 copay, w/o is 96.26


what is the patients balance. We are contracted with both insurances. I thought the balance would be 0 since the w/o of secondary is more than prime, but my co-worker disagrees thinks the balance should be the difference between the w/o amounts 13.85?

Can someone clarify how you handle secondary balances.

1. When secondary allows more than prime and
2. When they allow less then prime?

Thank you!

[Bready]

I am assuming that the secondary policy is not a supplemental policy to the primary. This is just a second insurance policy that the patient has, and as such both carriers will pay or process the claim according to the patient's coverage and your contract with them. Since this "secondary" is paying the claim according to your contract, you can only bill the patient the $20.00 co pay.
I believe I am correct on this but there may be some who have more experience with these types of claims. Hope this helps and doesn't make it worse

[shannaron]

so the total bill was 160. primary allowed 77.59 and it went to deductible. secondary allowed 63.74 and paid 43.74 and left 20 to copay. It is correct to charge the patient 20 copay. You would have gotten 63.74 (their allowable) if copay had not been charged. confused yet, I know I am. I have been doing billing and coding for ten years!