Medical Billing Coding - Primary & Secondary Insurance, cpt, codes
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Thread Topic: Primary & Secondary Insurance
Topic Originator: Sheila
Post Date March 30, 2005 @ 10:00 AM
Primary & Secondary Insurance

March 30, 2005 @ 10:00 AM Reply  |  Email Friend   |  |Print  |  Top

A child patient  of ours has primary and secondary insurance with the same insurance company under both of the parents.

The primary paid an amount stating a $5 copay but when the secondary paid, they are stating that there was a $15 copay and have paid accordingly. On the other procedures they have written on the second EOB differing amounts as well.

If we leave the account as per the primary insurance version - we will have to refund but if we follow the COB according to the secondary EOB we will obviously have to change/reverse the dollar/write off allocations.

Can anyone tell me which EOB takes precedence here? Does the secondary override the primary?

April 27, 2005 @ 11:11 PM Reply  |  Email Friend   |  |Print  |  Top

I suggest calling the insurance company and straightening it out with them directly.

Too much hassle to try and sort it out yourself....

June 28, 2005 @ 11:32 AM Reply  |  Email Friend   |  |Print  |  Top

Just because they are with the same insurer doesn't mean they have the same copays.  Every insurance company has many plans to choose from that offer an wide array of copays/coinsurance.

Even if they are employers plans, and the parents have the same employer, still doesn't mean they have the same copay.  My last employer offered a total of five HMO plans, each with a different copay level, and three PPO plans, each with a different copay level, and two indemnity plans, each with different coinsurance levels.

July 20, 2006 @ 8:22 PM Reply  |  Email Friend   |  |Print  |  Top


you are to bill according to the primary insurance EOB. That is why one is primary and the other is secondary. If the primary insurance did not pay then that would be different.

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