Billing secondaries

sdunaway1

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Hayden, ID
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Does anyone know if you can create a clinic rule that states that we will bill the secondary insurance a total of 2 times and make an attempt to collect on the balance after the primary insurance has processed . If we do not get an answer from the secondary policy we will then bill the patient and they can bill their insurance for the payment?

We have quite a few patients that have secondary insurance policies that do not want to process , stating that they have not rec prime eob , not received the claim etc..... We always send eob and these claims are a lot of time and money to process.

Please let me know if anyone else has done this in your office.

Thank you so much !!
 
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If the secondary payers are denying for reasons such as not receiving the primary EOB, I don't see how that would be fair to the patient to bill them instead. Not to mention the denial would have to indicate the balance is patient responsibility.

At my facility we have problems like this daily and with multiple patient accounts and there are easy ways to address it. The most simple way is to call and verify they haven't received it, then fax over what they need, preferably addressed to the rep you speak with, then either ask the rep to call you back when they got it or you can call the rep back to ensure they got it. If there's further issues, escalate the call to a supervisor or manager. There's always the option of certified mail. If all else fails, get in contact with the provider rep for the insurance company. This is especially true if it's consistently the same payer doing it.

From a customer service perspective, billing the patient without trying any of the above options is just not good practice and will only end up causing more grief (and work) due to patient complaints. Losing even one patient from your practice can harm the bottom line, much more than the work needed to get the claim paid.
 

joecorinn

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After we have billed the secondary insurance twice with no response, we have contacted the patient to let them know, and have requested that they call their secondary insurance regarding this. Within a few days we receive a call from their insurance stating that our claim will be paid. The patients have the insurance plan, and they should assume some responsibility for getting their claims paid.
 

cgaston

Expert
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Clarence, NY
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I think you have a responsibility to follow up on your claim submissions before dumping your problems in the patient's lap. Calling the secondary carrier to see if your claim has processed should be standard operating procedure for any billing company IMHO.
 

sdunaway1

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Hayden, ID
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Thank you for your responses- helpful information. We always follow up with the carrier to make sure the claim was received ,we also take note of who we speak with, send eobs numerous times. This is the reason for my inquiry - when we work a secondary claim for months it does not seem like good practice. Our intention is not to punish the patient it is to get them involved.

Again - thank you, it is always good to hear how others are handling this situation.
 
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