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Secondary Copay

mye1424

New
Messages
7
Best answers
0
Hello. Does anyone know if we should collect secondary insurance copay? 1 office I know they do not, another they do.
 
Messages
222
Location
Selden
Best answers
0
Practice decision

This to me is a practice decision and perhaps even as specific by particular insurance or patient.

For example, if a patient has Medicare primary and Cigna with $20 copay 2ndary, the patient will owe UP to the Cigna $20 copay. But if you wind up with 99212, the patient will not owe the full $20.

In our practice, any patient with Medicare primary, we tell them we will bill both insurances and will get a bill for any responsibility. If a patient has 2 commercial policies, we generally ask for the primary copay and if the patient has any objection or states the 2ndary will cover the primary copay, we don't collect and tell them we will bill both and will get a bill if any responsibility.

To me, it basically depends on whether you would rather deal with the hassle of potential refunds or bill the patient later.
And that's my 2 cents. Hope it helps.
 

Chelle-Lynn

True Blue
Messages
630
Location
Modesto, CA
Best answers
0
It would be based on your contracts with the primary and secondary carrier and the anticipation if any balance will be owed from the secondary carrier.
Example:

  • Patient present with Medicare and Blue Cross.
  • We know that Medicare will pay at 80% with 20% going to Blue Cross
  • Per the patient benefits you know that they will owe a $20 copay when the secondary processes the crossover claim

In this case it would be appropriate to collect the $20.00 at the time of service.

I would suggest working with your billing office to help set an office policy in regards to collecting monies at the time of service. They will be able to provide you with insight on how often they have to bill the patient after as primary carrier has paid, examples of scenarios, and possibly times when monies were collected and not needed.

This will help to reduce your office billing and refund costs.
 
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