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Primary/Secondary and Patient Responsibility

kwebsteranalyst

Contributor
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We are having a problem with knowing if when a patient has primary and secondary insurance if we are to bill the patient based on what the primary insurance states the patient responsibility is or do we go only by what the secondary insurance states is the patient responsibility and write off the rest as contractual?

I was taught that if the secondary insurance did not pay the total patient responsibility from the primary insurance that the patient would be billed for the balance.

Exp: Primary Insurance - Patient Deductible = $100
Secondary Insurance pays = 50
Patient Responsibility after both pay = 50

Thanks,
Karla
 

jromeyn

Contributor
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Your example is correct......unless the patient has Medicaid secondary in which case you can not bill the patient at all.
 

sande78705

Networker
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32
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We are having a problem with knowing if when a patient has primary and secondary insurance if we are to bill the patient based on what the primary insurance states the patient responsibility is or do we go only by what the secondary insurance states is the patient responsibility and write off the rest as contractual?

I was taught that if the secondary insurance did not pay the total patient responsibility from the primary insurance that the patient would be billed for the balance.

Exp: Primary Insurance - Patient Deductible = $100
Secondary Insurance pays = 50
Patient Responsibility after both pay = 50

Thanks,
Karla
As the patient has a deductible, he/she is responsible for that amount. If the secondary insurance picks up a portion that is helpful, but then the patient is responsible for the balance. As was mentioned before the only time we write the balance off is if the secondary insurance is a Medicaid insurance and therefore you cannot bill the patient. Medicaid will not pay a balance if the total paid is greater than what they would allow on the service.
Suzanne
 

kwebsteranalyst

Contributor
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Thank you so much. I knew I was right and we have a manager that is telling our staff they are to go by the secondary insurance information.

I just needed to have someone else back up what I was taught.

Karla
 

kmb511

Guest
Messages
1
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As the patient has a deductible, he/she is responsible for that amount. If the secondary insurance picks up a portion that is helpful, but then the patient is responsible for the balance. As was mentioned before the only time we write the balance off is if the secondary insurance is a Medicaid insurance and therefore you cannot bill the patient. Medicaid will not pay a balance if the total paid is greater than what they would allow on the service.
Suzanne
This seems to be a hotly debated topic. We are having the same issue in our office and, like Karla, I need something to back it up. Can someone give me an authoritative reference that states the patient is responsible for the balance if the secondary payment does not cover what the primary determined to be patient responsibility? (Medicaid being the exception)
 
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