Doctors billing primary & secondary ins company for same amount?

Question

Husband's surgeon billed our primary and secondary ins co's the same amt. We had been told previously that the secondary would be billed for only what the primary did not pay. Is this right? Sounds like they are really trying to get 100% of what they are charging as both ins co's disallowed a portion.

Cardiac dr said they bill primary and what ever is not paid they bill that portion to the secondary.

Anyone have any insight into this?

Thank you.

Answer 1

They are required to bill the same total billed charge to both insurance companies. This is probably what's confusing you.

When the secondary insurance company processes the claim, they don't go by the total number reflected on the bill to determine what they will pay - they use the Explanation of Benefits from the primary carrier to pay the leftover balance.

The reason that the actual bill to the secondary insurance company has to be for the same dollar amount that was billed to the primary is to make it easier to process and to know that they were being billed for the same services.

I've processed secondary claims before - you look at the total charges on the bill and compare them to the total charges on the primary carrier's Explanation of Benefits. If they don't match, you send the claim back and ask for a bill showing the same charges that were billed to the primary. Its standard procedure.

(Then you compare the bill to the Explanation of Benefits, look at any amounts that the provider is contractually obligated to write off for the primary, etc. When the secondary insurance processes the claim, they take a look only at the portion that was left as "patient responsibility" after the primary processed it.)

Sounds confusing, I know...unless you've handled the situation hundreds of times before. :) But, it sounds like the cardiologist's billing people did exactly what they were supposed to do.

Answer 2

For accounting purposes he has to bill both ins co's the same amount. However,when billing thesecondary ins, he has to show what hte primary ins paid.
This is coordination of benefits,
By the way, I'm glad you aretaking an interest in this. Too many people figure " I have ins,what do I care."
This has caused a lot of problems we have today.
Both co's should send you an explanation for what they paid. and you should review this carefully.
I hope yoiur husband's surgery was successfull and he is on the road to recovery.

Answer 3

OK .. here's how it goes ... if they are concerned about timely filing issues or not clear over which one is your primary insurance they will bill the two the same ... however for your secondary insurance to pay they must receive a eob (explanation of benefits) showing what the primary paid along with the insurance claim... they do this to insure there will not be any double dipping...

Answer 4

This is called coordination of benefits. Both insurance Companies are aware who the primary is and who the secondary is. This is common practice. Carefully look at the Explanation of Benefits (EOB) when they come in showing what was paid. If in either situation, the correct amount was not paid by either, you have full rights to inquire and get a clear and correct answer to this. Hope this helps. Good luck.

Answer 5

There is a 3rd option...get the bills (by law they must give them to you, just call and ask for the billing department). Bill the 1st insurance company and pay the 2nd. The birthdates of the insured persons usually is what determines the status of 1st and 2nd insurances (ie my birthday is in April and hubby's is in July...our kids would be covered under my plan 1st and his 2nd). So did the doctor's office know for sure which one was 1st and 2nd, it sounds like no and it isn't really their responsibility to figure it out. You are probably going to wind up having to do most of this leg work yourself now.

Answer 6

The insurance companies will figure ths out and only pay what they need to pay. They know who is primary and the secondary company will not pay until they know what the primary company paid.

If the surgeon is overpaid, if he/she is ethical, the office will return the overpayment.

Most doctors are ethical, a few are not.

Answer 7

I think medical billing is one of the biggest scams going on today. Most people don't care, as long as they are not paying the bills, so they don't even look at the bills, and each insurance company doesn't know what the other company is paying.

By Father-in-law, was on his death bed,(he dies a few hours later) and they wanted to start Chemotherapy on him. Hey if you get one douse in him, you can charge it.
We also were getting NEW bill for his short (4 days) a year later. How are we suppose to tell if these are legit charges.

Answer 8

Yes. I work in a medical office and can tell you that your Dr. is correct in the primary ins. should pay its part and only what is not paid by primary is supposed to be paid by secondary. Many big companies do whatever they think they can get away with- call your ins. companies and inform them of what is happening. They will make short work of it and will appreciate you notifying them of the problem.