18 Oct How to Handle Billing a Secondary Policy as a Primary Policy
In my career billing insurance this problem caused concern when the patient was dictating which policy to bill and which to not bill. The rule is to define through contacting the insurance companies which is the primary and bill that insurance first. When the primary pays or denies the claim send the EOB to the secondary to be processed under their policy provisions. To hide the existence of other payers from the insurance company to achieve higher reimbursement is considered insurance fraud. The following is a scenario from one eAssist biller who was faced with this situation:
Dear fellow eAssisters
Quick scenario that I haven’t personally had to deal with before and would like your input on how to proceed…
Patient came in for some restorative treatment. Claim was sent to the insurance company and was paid at a percentage. NOW mom presents additional insurance information. Upon verification of coverage, the office realizes that this additional plan should have been processed as primary according to the birthday rule.
What is the best way to handle this situation? I have an idea of how this should be handled but want to make sure before we proceed.
Answer from other eAssisters
Thanks everyone! Based on the majority of your responses I’ll be going with my initial plan to submit the claim to primary (like the other insurance has not paid). Once we receive payment from primary, we will submit a corrected claim to secondary, along with the primary EOB, so that they can reprocess the claim as secondary.
I’ve also suggested that the office let the patient know also that she has to be careful in situations such as this (withholding primary coverage to get payment from secondary first) because technically it’s insurance fraud. Could have been an honest mistake; I just don’t want her to think she can pick and choose which claims go to which insurance.