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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If you have a contract with the secondary insurance then you can't bill the patient for anything over the allowable. If the primary paid more than the secondary allowable wirte it off. Maybe this will help - take the allowable of the secondary insurance subtract what the primary paid. If there is anything left then you can bill that or the secondary should have paid (Primary paid $50.00 the secondary allowable is $55.00 then you can bill for the $5 if the secondary didn't pay. If the primary paid $50.00 and the secondary allowed $45.00 then you don't bill the patient).

If the patient only had the secondary insurance then you wouldn't have gotten the extra $5 anyway.