patient copayment

[simpham]

If primary insurance payment and patient copayment(paid in daily log) make $0.00 balance, should secondary insurace be billed or just post $0.00 for secondary to make claim done?

who can help me please?

[Steve Verno]

Use some simple logic.  Why would you bill the secondary?

If you want to bill the secondary, its your time and money to lose. 

[mdearfield]

Rightfully would this patient have owed the copay that they paid if they had a secondary that might pick it up?  I never understood why people carried secondary policies that paid hardly some if anything at all aboe theri primary policy.

[Steve Verno]

Im now confused as heck.

[Pay_My_Claims]

it depends on the plans as what you are supposed to have done in the beginning

ex: I have BCBS & Cigna. My bcbs is MY plan and primary, Cigna is my spouse's. My plan has a 15.00 copay and the cigna has a 20.00
Since the cigna is 2ndary, my copay should be 20. why?? Because if I pay the 15.00 copay, and my ded of 200 isn't met, then BCBS will apply the UCR to my ded, and the balance goes to Cigna. When cigna considers charges of the primary (zero), I will be responsible for what??? Any applicable deductibles and my COPAY of $20.00 . If I paid the 15.00 I will still owe 5.00

Also when dealing with a secondary, I always drop down EVERYTHING to the secondary (except when Medicare is primary). The secondary will review the primary payments. Sometimes the allowables on the secondary plan is higher than the primary (ex, Aetna is primary BCBS secondary,) If you adjust off after Aetna's payments, BCBS's allowables is HIGHER. You are adjusting off money that is due your provider. This is why sometimes you get payment in for claims and it is more than what is the balance on the account.

[simpham]

Thanks so much for all your replies.

What I am wondering here is the patient copayment paid before patients billed (paid when patient come to see doctor in office), so if I bill secondary carrier, this carrier may pay up to the balance made by primary and patient can take the copayment back (this would be great for patients who are not rich).
Please share your thoughts!

[Pay_My_Claims]

Thanks so much for all your replies.

What I am wondering here is the patient copayment paid before patients billed (paid when patient come to see doctor in office), so if I bill secondary carrier, this carrier may pay up to the balance made by primary and patient can take the copayment back (this would be great for patients who are not rich).
Please share your thoughts!

did the 2ndary require a copay???

[Danni R.]

I never got a co-pay back, and am under the impression co-payments are part of the agreement with the insurance company. Since it is the amount the insured must pay directly to the provider at the time of the service, it is solely the patient's responsibility. I don't think is is even allowed to refund it.

 Please correct me if I am wrong.

[mdearfield]

I always though that if a patient has a primary insurance that has a copay then they have a secondary that will pick it up then the patient will not owe a dime.  But say for instance is the patient has a 20 dollar copay on the primary but a 5 dollar copay on the secondary the patient should be responsible for the 5 dollar copay.  If it was me I would definately bill the secondary insurance for the copay that the patient paid and see where it leads.  Why would a patient carry a secodnary if they paid nothing at all?

[simpham]

I will submit some claims of this type to secondary carriers. We will be able to come to a conclusion when secondary carriers process claims.

[Pay_My_Claims]

I always though that if a patient has a primary insurance that has a copay then they have a secondary that will pick it up then the patient will not owe a dime.  But say for instance is the patient has a 20 dollar copay on the primary but a 5 dollar copay on the secondary the patient should be responsible for the 5 dollar copay.  If it was me I would definately bill the secondary insurance for the copay that the patient paid and see where it leads.  Why would a patient carry a secodnary if they paid nothing at all?

exactly what I said, you have to look at the 2ndary to determine how it coordinates benefits. If the 2ndary has no copay, you may have no OOP expenses. Danni you are correct, the copay is the members responsibility, however when dealing with COB, there are times when the secondary will pay that portion. In many instances what we would do when we didn't know if the primary copay would be paid by the 2ndary, we would wait to bill the patient after the claims were filed.  You must remember the 2ndary ONLY looks at the allowed amount.

EX bcbs allows 150.00 on a charge
they pay 80% ucr -minus the patients 50.00 copay
bcbs pays 80.00 balance from client 20.00 for their coinsurance

claim goes to cigna
cigna pays 100% ucr
they allow 140.00
bcbs paid 80, cigna can pay 60.00

we collected 50, 80, 60 for a total of 190.00 max allowable was 150, where does the 40.00 go??

[mdearfield]

Into our doc's pocket so we can get nothing........hehehe....just joking!!!!

[medauthor]

EX bcbs allows 150.00 on a charge
they pay 80% ucr -minus the patients 50.00 copay
bcbs pays 80.00 balance from client 20.00 for their coinsurance

This is a bad example, because only managed care plans have co-payments and there would not be a co-insurance due if the patient is being seen by an in-network physician; there would not be  $20 due for co-insurance in this case! 

[Pay_My_Claims]

not true

[medauthor]

what's not true?