Wiki Primary and Secondary Payer Question

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mauadajar

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Hello! We are out of network (OON) with the primary payer but we are in network (IN) with the secondary. If primary has no OON benefits, would the secondary pay for the visit?
 
Yes but you will need to submit to primary for denial. Patient would be better off choosing someone in both networks or there is no point in having two insurance policies.
 
After the primary denies the claim, would the secondary pay? Does that mean that the secondary pay as much as if it was primary?
 
Um...

...secondary would pay per rates. They might or might not pay more but don't expect maximum reimbursement because you're OON for Primary..
 
If secondary only pay a little it, can we charge the Pt to make up for the primary? Otherwise, it is not worth it.
 
The secondary should pay as though they are the only insurance (because in this case, they actually are). Your payment will be no different from what it would be if this patient only had that one policy and it were their primary.

The only difference is that you have to go through the motions of filing to the primary and getting a denial to send with the claim.

If there is any deductible, co-pay, or co-insurance, you can bill the patient as you normally would. (You can't balance bill the patient because you are in network, so you will write off the CO-45 as you normally would.) As I said above, you'll get paid exactly the same as you would if this policy were primary; you just have to take that extra step.
 
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