Wiki Reimbursement Question


Pittsboro, NC
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I'm hoping someone can give me a definitive answer to this question.

I know we can't balance bill but if the primary insurance pays their allowable and the secondary payer doesn't pick up the balance because their allowable would have been less than the primary insurances allowable can we bill the patient for the balance since the secondary didn't pick it up or do we have to write it off?

I hope this makes sense. Any help I can get will be greatly appreciated.
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Balance billing

You are not able to balance bill if you have a contract with the secondary insurance. If you are not contracted then you can bill the patient for the remainder.

Hope that helps
Thank you...
I want to be sure that we are allowed to bill up to the allowable, so if primary allows 100 and secondary allows 80, I should be able to bill the pt the 20 because I am billing the allowable amount? Or if the primary requires a copayment/deductible/coinsurance and the secondary doesn't cover it, I can still bill the patient for their copayment/deductible/coinsurance?
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You can only bill the patient up to the lowest contracted amount. So if the secondary did not pay because the contracted amount was less than the primary AND you are contracted with the secondary, then no - you can not bill the patient. Seems unfair, I know, but you agreed to accept the lower rate when the contract was signed.