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When a primary insurance pays more than the secondary allowable is the remaining balance the patient's responsibility?
Wiki User
∙ 14y ago
Yes it is patient responsibility
Wiki User
∙ 14y ago
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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.
How do you determine primary and secondary coverage for an adult patient covered by two full benefit polices?
Check this page for the answer http://www.steveshorr.com/law_relating_to_insurance.htm primary policy will be medicare&secondary will bethe patient's commercial insurance company.as medicare covers all.the remaining which is not allowable wiill be covered by secondary
Is primary insurance copays covered under secondary insurance?
Depending on your coverage, your primary insurance will cover 80% of your charges, minus your deductible (if not already met). Your secondary insurance will pick up the remaining 20% co-insurance and your co-pay, if you have one.
If you have a copay with your primary insurance but also have secondary insurance do you have to pay the copay before treatment?
Depends on the doctors office billing procedures. For more details visit www.SteveShorr.com yes, your secondary insurance should cover this amount if you have reached your deductible with them. Normally, if the primary insurance applies a deductible or co-insurance/co-pay and you have not met your deductible on your secondary policy, depending on your policy they may apply the remaining balance to your deductible. Normally after the deductible is met on the secondary ins. they pay 100% of your remaining balance.
What if you are driving someones car that doesnt have insurance and you get in an accident but you did not know they did not have insurance?
Usually, it is the responsibility of the owner. However, if you have insurance on your vehicle, they will step in as secondary coverage...including covering the damage to the vehicle you were driving, if you have the coverage.
Will secondary insurance pay the co insurance amount of primary insurance if you have met the deductible in secondary insurance?
Yes
Will secondary insurance cover claims denied by your primary insurance?
As long as it is a covered expense by your secondary insurance and a claim has been filed with the primarty insurance then the answer is yes. The secondary insurance will only cover the expense according to your plan.
My husband's insurance covers his daughter as the primary but her mom carries dental for her now her insurance is refusing to cover her orthodontia due to the fact they are secondary- is this legal?
You do not say what state you are in and the exact answer could be a function of the insurance law for coordination of benefits in your state. However there also could be a specific provision in the Mom's policy--usually titled non-duplication of benefits--that says it does not pay if other insurance exists.Without a non-duplication provision, in general if the primary insurance company covers orthodontia, it will pay first and then the secondary insurance will pay some additional portion. There can be differences state to state but in general it works this way:The primary carrier pays the claims as if there is no other insurance involved. The COB law requires the secondary carrier to calculate what the benefit would have been for the claim if there were no other carrier involved, but allows the secondary carrier to deduct the amount paid on the claim by the primary carrier from its payment. The secondary carrier then pays the claim up to 100% of the allowable expense if the benefit contained in the policy is great enough. So, if the dentist's charge for ortho is $1000, but the allowable expense is $800; the claim will be paid based on $800 being the maximum that can be paid.There are two exceptions to this general rule. First if the primary carrier is a DHMO and the patient does not use a DHMO provider, the secondary carrier must pay the claim as if it were a primary carrier. As well, self-funded and collectively bargained employer groups operate under federal law and do not have to follow state COB laws. These groups often utilize "non-duplication" provisions to lower premiums. These provisions provide that that the insurer will not pay for benefits that are reimbursed by other insurance. Where these provisions are present in the patient's policy, there may not be any payment from the secondary carrier.An allowable expense is the usual and customary or maximum allowable expense for the dental service when the item is covered at least in part under any of the plans involved. When a covered person is covered by two or more carriers which determine benefits on the basis of usual and customary fees or maximum allowable expense, any amount in excess of the highest usual and customary or maximum allowable is not an allowable expense. When a covered person is covered by two or more carriers, which determine benefits on the basis of contracted fees, any fee in excess of the highest contracted fee is not an allowable expense.You might want to contact the consumer representative in your state Department of Insurance to help sort out your policy provisions.
Does secondary insurance cover or pay copays of primary insurance?
The secondary insurance cover both pays and co-pays of the primary insurance depending with the insurance company.
Will secondary private insurance pay deductible from the primary insurance?
Some will. Check with the secondary insurer.
What do you do if your doctor does not submit to your secondary insurance and now its denied for timely filing?
appeal to secondary insurance
Does secondary private insurance pay what primary private insurance will not pay?
Yes, if the secondary insurance plan covers it In the pharmacy (drugs) world of primary and secondary coverage, this is true.
