Wiki Two BCBS insurances, which one is Primary?

[lhaney217]

We had patient who is 61 years old that came into our office today. He stated his primary insurance was a BCBS retiree plan, his secondary was BCBS through his employer. He stated the reason the BCBS retiree plan is his primary is because it pays better, I ran his insurance and his secondary does have his BCBS retiree plan listed as the primary payor. But I could not find anything online to confirm if this was accurate, that the patient could choose which insurance he wanted as primary based on which one pays better or his employer insurance needed to be primary since he is still of working age and currently employed with them.

 

[SharonCollachi]

People don't get to choose which is primary based on payment.

GENERALLY, the insurance of the person with full-time, active employment is primary. Anything else is GENERALLY secondary. I would call his active insurance plan and ask why they are secondary to a retiree plan, then I would call his retiree plan and ask if they know they are paying primary to an active plan.

 

[thomas7331]

I agree, this is not the patient's choice. The plan rules determine how and when they will coordinate with any other insurance the patient may have, and I agree with the above that an active employee plan will almost always act as the primary payer, but there may be exceptions. It would be up to the insurance to make this determination.

 

[Mayzoo]

I believe in Availity, it will tell you which is listed as Primary when you do an eligibility check. If not or not available, you can call BCBS and they will know.

 

[SharonCollachi]

I believe in Availity, it will tell you which is listed as Primary when you do an eligibility check. If not or not available, you can call BCBS and they will know.

The only problem is, we know who is LISTED as primary, but we believe the information is incorrect.

 

[Mayzoo]

The only problem is, we know who is LISTED as primary, but we believe the information is incorrect.

Yeah, then you (or OP) need to contact the patient to get current COB information. Blue Cross may or may not accept your forms, so you also need to get the patient to call the number on the back of their card to update their COB with Blue Cross. At least in my opinion, but I am still kinda new at all this .

 

[SharonCollachi]

Yeah, then you (or OP) need to contact the patient to get current COB information. Blue Cross may or may not accept your forms, so you also need to get the patient to call the number on the back of their card to update their COB with Blue Cross. At least in my opinion, but I am still kinda new at all this .

You're absolutely correct. Some insurances will take the information from only the patient, some will take it from anybody. When you tell them, "I think you're paying out far more than you're supposed to because I think you should be secondary," they DO tend to stand up and take notice! The problem with asking the patient to call is the patient doesn't see any problem, often won't call, or won't say the right thing. I do like to make contact with the insurance so they know some of what is happening, when/if the patient contacts them.

 

[Mayzoo]

You're absolutely correct. Some insurances will take the information from only the patient, some will take it from anybody. When you tell them, "I think you're paying out far more than you're supposed to because I think you should be secondary," they DO tend to stand up and take notice! The problem with asking the patient to call is the patient doesn't see any problem, often won't call, or won't say the right thing. I do like to make contact with the insurance so they know some of what is happening, when/if the patient contacts them.

Thanks for the confirmation. It helps a newbie like feel a little more confident.

After we have exhausted all other routes, we will send the patient a bill for the amount the insurance says is pt responsibility due to no COB on file. The insurance has usually tried 2-3 times to get the COB, and we have usually tried 2 times. That usually seems to get them to call their insurance.

 

[SharonCollachi]

Thanks for the confirmation. It helps a newbie like feel a little more confident.

After we have exhausted all other routes, we will send the patient a bill for the amount the insurance says is pt responsibility due to no COB on file. The insurance has usually tried 2-3 times to get the COB, and we have usually tried 2 times. That usually seems to get them to call their insurance.

Good job. The reason I try so hard to get it right the first time, is that I've had primary insurance come back and recoup the money a couple of years later, saying they weren't primary, then we're left trying to get payment and pick up the pieces.