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Question Coordination of Benefits Question

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We have a patient who has both Blue Cross Blue Shield of South Dakota and Medicare. He has not coordinated his benefits and chooses not to coordinate his benefits. We have submitted the charges to both insurance and both insurance paid as primary causing the claim to be overpaid. We tried to send an inquiry to Blue Cross to refund them and they refused stating that they are Primary. We tried refunding Medicare and upon an investigation of the patients insurance, they also refused to take the refund. Now we have an over-payment of $384.92 and we are not sure what to do in this situation. The provider is afraid of getting in trouble for getting overpaid for the services because both paid as primary. How do we proceed on this account?
 

trarut

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Which plan should be primary based on what you know about the patient's situation? Did Medicare and BCBS issues those refusals in writing?
 

trarut

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If your patient is 65 or older and is working (or the spouse works) with group health insurance, Medicare is likely secondary if the employer has 20+ employees. You may want to check out this page at Medicare.gov: https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance/which-insurance-pays-first.

In the circumstance you describe, we document the visit, attach scans of the payer letters saying they won't accept the refund and move on. We've done our due diligence by notifying them, can't force them to accept the money back. There is a special code in our practice mgmt system that is used to adjust off the credit balance so that we can find (and reverse!) the balance in the future when one of the payers figures it out.
 
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