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balance after primary and secondary

  1. Default balance after primary and secondary
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    If primary insurance ( and they say allowed amount for charge is $120) pays $100 and then has contractual adjust of $100 and says coinsurance balance is 20 dollars. Then when you send it to pts secondary insurance they say allowed amount was only 102.00
    ( and contractual amount should be 118)
    and they pay nothing and say pt responsibility is 2 dollars.
    ??? does pt owe 2 dollars or 20 dollars????
    I see this on occasion and no one seems to be sure of the answer.

  2. Default
    Medical Billing
    Based on the remaining patient balance after primary insurance paid, the secondary insurance needs to make it clear on their EOB just what you're supposed to do with that $20. If the 2nd allows less than the primary insurance does, and they're not going to pay anything, then patient balance should remain $20. I would definitely call the 2nd insurance and have them go over the primary EOB with you and have them tell you how to interpret their secondary EOB. If they're going to be vague with their EOB's, make them explain it over the phone so there's no uncertainty on your part. Good luck!


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