Wiki Insurance Payments

[jcochran]

So, I have an issue here, and I haven't really been able to find a distinct answer.

I have a client with BCBS insurance primary and Cigna 2ndary. Her BCBS is a high dedcutible plan, and her Cigna has a $25 copay.

We aren't in-net for Cigna, and Cigna is paying all of the charge minus the $25 copay, and is completely disregarding the contractual agreement we have with BCBS. Cigna is paying more than the BCBS allowable, and telling me to bill the client the remaining $25.

What do I do legally? I know I can't bill the client for charges above the BCBS allowable, and when I post Cigna, it's putting a credit on the client's account. I am very confused by this.

Please help.

 

[penguins11]

I would call Cigna and point out that they are disregarding the primary write off. If they still will not take the money back, I would send them a letter stating what you feel they should request back, certified if you can. You can't force them to take money back and if you send it back to them, they will just send it back to you. (I have gone through this with CIGNA). I would bill the patient for the $25 copay and document everything that you have done. That way, you have proof in the future that you tried to give the money back to CIGNA but they wouldn't take it.

 

[slivingston]

I used to work for an insurance company in the coordination of benefits department and it sounds to me as if both insurances are process the claim as if they are the primary. You may want to start by contacting Cigna and asking if they are aware that the patient has BCBS as their primary and if not the patient will need to reach out to both insurances to update their files. As there is a slew of rules that determines which insurance is actually their primary.