Wiki Secondary allowance is lower than Medicare

CatchTheWind

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My understanding has been that if a patient has Medicare as primary and a commercial policy as secondary, and we are in network with both, we are allowed to collect the full Medicare allowance even if this is higher than the secondary's allowance. We now have a secondary payer telling us that we have to accept their allowance even though it is lower than Medicare's.

Does anyone know what the rule truly is?

Thanks!
 
It may depend on the COB provision or possibly state guidelines. Typically if you are participating, secondary payer is liable for no more than it would have had it been the sole coverage. Having dual coverage is to benefit the patient not the provider.
 
I understand that they are not going to pay more than their allowance. But they are saying that we can't bill the patient for his Medicare co-insurance because the 80% of the Medicare allowance that Medicare paid is more than 100% of their allowance.
 
I understand that they are not going to pay more than their allowance. But they are saying that we can't bill the patient for his Medicare co-insurance because the 80% of the Medicare allowance that Medicare paid is more than 100% of their allowance.

You are bound to the reimbursement terms of the secondary contract since you are contracted. If the payer considers what Medicare paid as payment in full, billing for any more would be balance billing as secondary shows no patient responsibility.
 
Is Medicare automatically deemed primary?

Peace
@_*
I have a claim where both insurance entities claim to be secondary.
 
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