MEDICAL BILLERS HELP!! Medicaid as a secondary....?

Question

I currently have Unicare with a $35 co-pay and a $1000 deductable. My secondary is Family Care which is a form of Illinois Medicaid and it has a co-pay of $2. I have graduated medical billing and am pretty sure on the answer to my question, but I need to know how to prove it if I am correct.

My husband has been assigned to go to physical therapy. They accept both insurances. They are trying to tell my husband that there is a $30 co-pay because they are physical therapy.
My assumption was that with a secondary or co-insurance you are to bill the patient after you have billed the other sources. When you recieve the EOB from the primary (Unicare) you bill the remainder, which includes the co-pay, to the secondary (Medicaid). Then the secondary insurance's EOB shows what is left of the member responsibility. Therefore the only thing we may have to pay is the $2 Medicaid co-pay.

PLEASE HELP!!

Answer 1

OK, this probably doesn't answer your question but it caught my eye because I am a PT practicing in IL and we accept public aid and unicare at our facility. My experience with Unicare (if PPO) is that they don't have a $30 co-pay...they only COVER $30 each visit (normally leaving the patient with about a $190 co-pay)...and they only cover 12 visits. The HMO covers better, but you are limited to 30 visits a year.

However, if you are going to a facility that accepts P.A., you shouldn't have to worry anyway.

...and I believe you are correct about the billing procedure...but I cannot confirm that...

Good luck with his rehab.

Answer 2

I do not have any experience in billing but we have a primary and secondary. Our primary is a copay of $10 with a deductible of $750 per person. The secondary has no copays so we pay the $10 copay and then they bill the primary first then the secondary. You would think that they would bill in that order and you guys pay the remainder which would be the $2. If they give you problems just tell them to bill the insurace companies first and you will pay the copay when you receive the bill. Sorry I cannot answer your question with 100% certainty. Hope you find the answer you are looking for. Good luck :)

Answer 3

Not every provider is equiped to bill secondary plans. I would check that out first. If they are not set up to bill secondaries, then it's your responsibility to turn it in. (In which case, you'd speak to your Medicaid caseworker about what to do - most likely, you'd give the bills to the caseworker.)

If they ARE set up to bill secondary plans, make sure they have all the proper info - sometimes, if one digit is transposed, it'll come across as not valid and then they'd be within their rights to bill you for everything.

The other reality is, as someone else stated, PT is not exactly the same as medical care. It falls under a slighty different heading, and the rules that apply to your regular doctor may or may not apply to the physical therapy. You would also need to speak to Unicare (since that's the primary) about what exactly is allowed under your PT coverage.