Wiki Primary & secondary insurer

[etenndixiechick]

I do coding but don't have much experience with the back-end EOB side of things. If a patient has a primary insurance and a secondary and the primary pays/adjusts everything except the $25 co-pay and the secondary insurance EOB shows a greater adjustment than the primary, is the provider required to take the greater of the adjustments if the provider is contracted with both insurances leaving the patient potentially with $0 co-pay potentially? I have a lot of people telling me yes and one person telling me no. If so, is there anywhere that is available in writing?

 

[tblmt1966]

If your office is a contracted provider with that insurance and filed the claim to the insurance with assignment accepted then yes you have to adjust the bill per the EOB.

Now, if your contract allows you to file secondary insurance claims as not accepting assignment then you can collect the copays, deductible and co-insurances from the patient.

 

[Herbie Lorona]

Yes an easy way to look at it is you will not get more then the secondary insurance allows. So it all comes down to how much the secondary allows and how much the primary paid. You may get the full copay amount, a partial amount of the copay, or you will have to adjust the whole copay off. Feel free to email me if you have any questions.