How is a patient who has secondary insurance billed?

Question

I need to know how to bill a patient who has both primary and secondary dental insurance. Is the patient's co-pay limited to the primary carrier's contracted amount or, because of the secondary, would they owe the full doctor's fee? If the secondary carrier's payment doesn't fully cover the patient's co-pay portion, what amount is the patient then responsible for? If the provider is bound to the primary carrier's contracted fee, regardless of what the secondary allows, does any remaining charge exceeding that contratced amount get written off? If the patient has deductibles on both plans, do they owe both deductibles? If I have left out any relevant questions, any and all pertinent information would be most helpful. Thank you.

Answer 1

As "Zippy" suggests, you can bill the patient after you receive the primary's response to the claim. However -- you can ONLY do this if you don't participate with the secondary. If you're also a par provider for the secondary, you cannot bill the patient instead of billing the secondary. That would be a blatent violation of your contract with the secondary.

Assuming you participate with both, your best tactic is to send the bill along with the primary's EOP to the secondary. Let the secondary tell you what the patient is responsible for. Some secondary contracts cover the primary's co-pay and others don't. You won't know what the patient is truely liable for until the secondary processes the claim.

Your office's agreement to accept the primary's fee as payment in full doesn't prevent you from attempting to collect payment for the patient's co-payment from the secondary. However, if there is no co-pay remaining after the primary has paid, AND you're contractually bound to accept the amount the primary has paid as payment in full, there's nothing to bill the secondary, is there?

Answer 2

My office (which is a medical office) deals with secondary insurances this way: we only bill the primary plan. Anything the primary plan does not cover (copay/deductible/etc) gets billed to the patient. The patient must then either pay us and get reimbursed by their secondary plan or turn in the bill to the secondary plan and then mail us the payment. (Depending on the secondary plan - GHI will not pay a patient, only a provider.) BUT - if they opt for the latter, they MUST inform the office within 30 days of being billed.

Why make yourself crazy? It's really the patient's responsibilty to know their insurance - after all, they only have one or two plans to deal with. Offices have hundreds. When in doubt - put it on the patient.

Good luck!

Answer 3

Suzanne is dead on!

Your questions are all valid... but have many different answers. It all depends on how their benefits coordinate, and which plans you are contracted with...

The ultimate bottom line, the patient will never owe more than their one copay/ded..... And you will never bill the patient for an amount that one of the insurance companies designates as a participating provider write off.

Answer 4

if a pt has primary and seconday ins. it's the pt first time billing the primary ins so we billed them a new pt. 2ndary denied because pt is an established pt for them , how do I billed 2ndary ?