Wiki UBH as secondary Ins

monalisa

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Hi,

I was wondering if someone could help me answer this question,

Here is an example:

Pt has Medicare as primary, primary pays there allowable is $70.09 and then we bill the 2nd UBH the coinsurance due of $ 23.51, which UBH denied due to there contract rate is $65.00?

I have not come across this, so if anyone can give me correct information on this and where I may find documentation that would help?

Thank you in advance,
MonaLisa
 
Secondary or tertiary insurance will pay up to their contracted maximum allowable. If primary pays more than the other insurance's maximum contracted rates, then per the contract you are expected to accept the primary's payment as payment in full. The problem I have run into is that the primary insurance has a contract with the provider that you as provider are expected to collect from the patient their part of the total allowable. This is why you should not accept contracts with insurance plans that pay less than the Medicare allowable rates.
 
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