Wiki Medicare deductible

[kvonholten]

If Medicare processes a claim towards a deductible ($135) and the secondary pays ($91) based on their allowable ($106) and leaves a $15 copay, is the patient still responsible for the balance of the Medicare deductible ($44) and the $15 copay?

 

[maebelle@gmail.com]

Curious...Is the secondary policy processing the claim as primary?

 

[kvonholten]

It looks like they are.

 

[SharonCollachi]

Depending on your contract with the secondary, the patient may or may not be responsible for more than $15.

No matter what, you cannot collect more from the patient than Medicare says you can, so in my world, the patient is responsible for $44. You cannot collect $44 plus $15.

I do not allow secondaries to "drive the bus"... they have to follow the rules of the primary. So in my world, the account would look like this:

Medicare deductible $135
Secondary paid............$91
Balance remaining... $44

Patient owes $44.

If you DO allow secondaries to reduce patient responsibility from the primary, then you would only collect $15 from the patient.

 

[tillerlw2]

Depending on your contract with the secondary, the patient may or may not be responsible for more than $15.

No matter what, you cannot collect more from the patient than Medicare says you can, so in my world, the patient is responsible for $44. You cannot collect $44 plus $15.

I do not allow secondaries to "drive the bus"... they have to follow the rules of the primary. So in my world, the account would look like this:

Medicare deductible $135
Secondary paid............$91
Balance remaining... $44

Patient owes $44.

If you DO allow secondaries to reduce patient responsibility from the primary, then you would only collect $15 from the patient.

This is becoming a bigger and bigger issue and I agree with you. I just wish there was something in writing I could reference. Signing a contract with a secondary payor does not make all primary contracts null and void. That is crazy talk. If we have a contract with medicare, then we are not only allowed but obligated to collect the deductible from the patient. If their non-medicaid secondary does not cover that full amount, the patient has to pay the remainder. It is their responsibility by contract, if they satisfy that responsibility with a second or 3rd insurance, that's great. But in no way does the secondary override our contract with the primary payor.