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I will use for example someone on MEDICARE.

They have paid into their medicare insurance and have both parts (thus eliminating confusion of part a, part b).

First the bill is sent to the Medicare insurance provider, who will have an allowed amount and then of that what they will pay. The billing medical source credits what MEDICARE paid and then submits the balance to the 2nd or CO-INSURANCE. As a whole, if MEDICARE pays 90%, the CO-INSURANCE picks up the balance of 10%.

These figures were used as an example. You will have to know your own breakdown of what percentage is paid. Remember is is on the ALLOWABLE or APPROVED amount, not the whole billing. Most insurance such as MEDICARE and personal insurance through a work place, have a provider adjustment. Then the % is taken from there. PRIVATE holders of medicare and co-insurance my not have the luxury of an adjustment of cost. And will have to cover what is left.

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โˆ™ 2013-05-04 02:07:40
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Q: How is billing handled for a patient with dual insurance?
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What does it mean for a patient to have dual insurance coverage?

This refers to the case in which a patient is insured by more than one insurance plan. For example, a Medicare patient is generally covered for 80% of charges for a physician visit. In this case , he or she would usually be responsible for the remaining 20% of charges. However, if he or she has dual insurance coverage and is also covered by a supplemental plan. Medicare plus, this secondary plan would generally pay the amount not covered by the patient's primary insurance plan, Medicare.

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