Wiki Secondary Allowable lower than primary

[cwoodall]

I've read a lot about the allowables being different on here but typically the case is where both insurances are paying. I have where primary commercial insurance left everything towards deductible and secondary (Tricare) paid and left only a $31 copay but the allowable is over $40 lower. Can I only leave $31 to the patient when their primary left more being applied towards their deductible? I would think patient should be responsible for their deductible which would mean the difference in the allowable? Thanks!

 

[thomas7331]

Providers are required to abide by the contractual or legal terms of the secondary plans as to what amounts must be accepted as payment in full for a claim, so in this case you can only bill the patient for the amount that Tricare has stated is the patient responsibility. The patient is still 'responsible' for their primary deductible, but in this case, that responsibility has been met (less the $31) by their benefit provided under the terms of their coverage with Tricare.