Health Insurance billing question

[Tuffcookie]

I just got a bill from the hospital for an ER visit for youngest DS. He got stitches in his arm. My ex took him on 04-04-09.

My insurance is primary, my ex's has secondary. My insurance paid everything except $153.86. That is toward the deductible.

Should the secondary insurance claim pay anything towards that balance? I thought with 2 insurances neither my ex or I should have any out of pocket expenses.

TC

 

[HM]

I have two insurances on me. In the past, the second has often covered the co-pay for the other, but not always. It never hurts to send in the EOB from the first insurance with a copy of the bill, to the second insurance. Nothing ventured, nothing gained.

 

[Tuffcookie]

Thanks, that's a very good idea!

TC

 

[MELISAZACK]

I am wondering something similar.. my DH has medicare primary and BcBS secondary - he just had back surgery we see the bills going through medicare first being paid what they are owed and listing his deductible.
then I can see the providers then billing BCBS FULL price again for the same charges and getting money from them as well.. they are not just billing for the copay amount. It appears they are double dipping but I am not sure.
all I know is so far almost 2 months out we haven't seen a copay bill yet. I am sure they are coming but I don't know what they will be??

 

[DisneyAngel83]

I work in billing for a small medical office and this is how it generally works...

First we bill the primary insurance company, they make their payment, we do a write-off (or discount) to match the allowable rate we are contracted with and the patient has a portion they owe (unless the insurance covers 100%)....

then, we bill the secondary, once again at the full billable rate, but they get to see the primary EOB (or how the primary ins paid). Some secondary ins coordinate with the primary and some consider the charges separatly. It is not double dipping to bill the full rate to the secondary because we are also sending the primary payment info.

The way a secondary pays is all in how your policy is written... and all groups have different rules. If you want to have an idea of how they might pay before a claim is sent, always call your insurance company, they won't tell you anything exact, but they might be able to help you understand your policy.

As a medical biller, if there is one thing that irks me is that these days no one fully understands how health insurance works and everyone just points fingers at everyone else when the insurance co doesn't pay a claim. The insurance co says the medical office didn't bill it correctly and while that can be true in small percentages, from a provider perspective, the insurance co just doesn't want to pay the claim... and mind you we have already provided the service and are now fighting to get paid! And the patient is stuck in the middle with most all the financial liability, but no power.

 

[bigbabyblues]

It depends on how the second policy is written. Some will pay the deductible from the primary carrier, some won't. Some will say the primary paid more than they would have, and they won't pay anymore at all.