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If primary insurance pays more than what the secondary allowed?
Wiki User
∙ 11y ago
The balance gets adjusted.
Wiki User
∙ 11y ago
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When will secondary health insurance not pay?
if primary paid more than allowed amount or if patient has primary insurance
If the secondary insurance has a higher allowed amount than the primary insurance is the secondary required to pay the higher amount?
I need more details in order to answer this question.
If Primary insurance paid more thatsecondary would allow. Is patient responsible for deductible and coinsurance?
Is the patient responsible for deductible and coinsurance if primary insurance paid more than secondary would have allowed.
When a secondary insurance allows more than primary allowed can you keep overpayment?
If I'm not mistaken, and I could be wrong, when the secondary insurance allowes more than the primary, the primary contractual adjustment is voided and the contractual obligation of the secondary should be applied. This will cause the balance to be zero when the adjustment of the secondary is the reflecting contractual obligation. That is how I was taught and it does make sense.
If the primary insurance allows more than the secondary insurance what would the secondary insurance pay?
Secondary insurance will not pay the claim but the remaining charges should not be billed to the member/patient. Provider of service should write off the patient responsibility that primary insurance applied.
If you have a 900.00 deductible on your primary insurance and none on the secondary insurance can the secondary be used to cover the deductible?
Yes. For more info. see www.SteveShorr.com/supplemental.htm
Can medicare be used for secondary insurance if the primary insurance is paid by your employer?
Medicare is primary if your group is under 20 lives. 20 lives or more and medicare is secondary to your employer paid group plan.
Will secondary insurance pay the co-insurance amount of primary insurance if you have met the deductible in secondary insurance?
You're going to have to look at your policy or brochure to see what the provisions are. For more details see www.steveshorr.com/supplemental.htm
Can you change your secondary insurance to primary insurance if your coverage is better with the secondary insurance?
In most cases no. You can not chage due to better coverage. 90% of insurance companies, if not more, have what is called a birthday rule. Meaning if you have dependant children on the policy the guardian who was born first (or who is older) is the primary carrier for the dependant children and the younger of the two guardians is the secondary carrier. If you were to have coverage through yourself and a spouse you would be your own primary, as would your spouse be their own primary. If you are the carrier for both insurances then it would all depend on your plan provisions and restrictions, in which case you would have to question each insurance company as to how they would handle determining what insurance is primary and what insurance is secondary.
When a primary insurance pays more than the secondary allowable is the remaining balance the patient's responsibility?
Yes it is patient responsibility
Does a medical provider have to take a secondary insurances' write off?
It depends. The first question to be answered is whether the medical provider has negotiated a contract with that insurance company. If not, then the secondary is responsible for 100% of the balance left by the primary--no adjustments allowed. The entire balance must be paid by either the insurance company, the patient, or any combination of the two. It's different if there is a contract in effect with the carrier. Nowadays, many insurance companies process those claims in any one of several ways. They can compute how much they would have allowed (the total of ins resp + pt resp) had they been primary. Having done that, they'll subtract the amount pd by the primary and pay the balance--if there is one. If the primary had paid more than the secondary would have allowed had they been primary, the secondary may not pay anything and the balance left would have to be adjusted off. Sometimes the secondary doesn't consider what the primary paid at all, and both companies will pay as primary..it can make a difference whether the other insurance that is listed as primary is an individual or a group policy; and the same for the secondary. Group plans trump individual plans. When they both pay as primary, and neither insurance has processed the claim incorrectly and the provider has now ended up with a legitimate credit balance on the claim, the provider has 3 choices at that time. They can refund the balance to the insurance plan that created the credit balance; they can send the overpayment amount to the patient; or they can keep the money and deposit into their account.
Are health care providers obligated to accept payment from a secondary insurance with whom they participate when the provider does not participate with the patient's primary insurance?
Yes they will have to accept payment from the secondary insurance, however they will have to bill the primary provider first. What ever the primary insurance does not cover should be covered by the secondary insurance. However, it will depend on the service being provided and the contracted amount that each insurance has agreed to pay. If the primary pays more than the secondary would have paid -there may be a refund due. However, there may be co-pays and deductibles to be met with both insurance policies. There could also be write downs--- you should only pay the lesser amount the provider may have to take a loss if one insurance has a lower contracted amount
