Question Balance billing

dhobbs6

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DeKalb, IL
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I have a question about a situation I have been running into at my current employer that I do not agree with. I have been seeing patients who have primary and secondary insurance. We are contracted with both companies so are in network. In some instances, the secondary allowed amount is less that what primary paid so no secondary payment is forthcoming. Secondary then is expecting us to write off the balance. The EOBs read as a Contractual Obligation remark codes with no patient responsibility showing. But the corporate office is not adjusting these secondary contracted amounts. They are balance billing the patients. When I questioned them they stated we are only obligated to take the primary's allowed amount and therefore ingnores the secondaries, even though we are contracted with them. Then they are balance billing the patient's for this amount and asking me to call them to collect. I feel like this is not good practice. I feel like this may not even be legal quite honestly. But then again I am not sure. Any help?
 
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I have a question about a situation I have been running into at my current employer that I do not agree with. I have been seeing patients who have primary and secondary insurance. We are contracted with both companies so are in network. In some instances, the secondary allowed amount is less that what primary paid so no secondary payment is forthcoming. Secondary then is expecting us to write off the balance. The EOBs read as a Contractual Obligation remark codes with no patient responsibility showing. But the corporate office is not adjusting these secondary contracted amounts. They are balance billing the patients. When I questioned them they stated we are only obligated to take the primary's allowed amount and therefore ingnores the secondaries, even though we are contracted with them. Then they are balance billing the patient's for this amount and asking me to call them to collect. I feel like this is not good practice. I feel like this may not even be legal quite honestly. But then again I am not sure. Any help?
I would suggest reaching out to your payers, especially your larger ones getting copies of your contracts. In my 15+ years in medical billing you can not bill the patient for more than what the secondary states, so if that mean secondary states patient responsibility $0.00 then you can not bill the patient.
 

trarut

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I would suggest reaching out to your payers, especially your larger ones getting copies of your contracts. In my 15+ years in medical billing you can not bill the patient for more than what the secondary states, so if that mean secondary states patient responsibility $0.00 then you can not bill the patient.
👆 What rthomas said. Some secondary plans use their own primary allowed amount instead of the primary allowed to calculate patient responsibility and you cannot balance bill. Believe me, we've accidentally put balances out to the patient when we've had new staff and the payers have not hesitated to call and school us on what's appropriate.
 

thomas7331

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I agree with the posts above. If the secondary payer is a government plan (e.g. Medicare, Medicaid, TriCare), then it is most likely illegal to balance bill the patient for any amount in excess of what the secondary EOB states is due. For commercial plans, if your provider is contracted with the secondary insurance, then it may not be illegal but it is probably a breach of the terms of the contract with that payer. I would be surprised if this practice could continue very long this without generating complaints from the patients and/or payers.
 
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