Wiki Primary insurance approves, secondary denies

[SummerRaye97]

Patient's primary insurance approved a test and applied to her deductible. Patient's secondary insurance denied stating that testing is not covered by her plan. Does the patient get billed for the balance left from the primary insurance deductible?

 

[Kholloway]

Is its not covered or deemed experimental?

Typically in our office we will file with both insurances but if assignments are selected for the secondary insurance you have to honor their ruling. For example: BCBS primary was forwarded to Tricare secondary. We had to w/o the difference in the allowable because Tricare is significantly lower than BCBS.
If its experimental then I would say its most likely a write off. Depending on the type of denial it may be eligible to bill the patient for the services.

 

[greatbiller]

If it is not a covered benefit of the patient's secondary insurance, you can bill the patient. The explanation of benefits from the secondary insurance should indicate if it is billable to the patient. When in doubt, call the carrier for confirmation.