Question
What is the name of your state? PA
If i am covered under 2 insurance policies and my pri**** pays their allowed amount and per the eob is supposed to adjust the balance with no liability on my part can they legally bill my 2ndary?
also:
if the 2ndary has a higher allowance can they legally keep the difference?
by the way my provider is participating with both of my insurances.
thanks
Answer
If pri**** paid 100% of charges or allowed amount based on the contract no they cannot bill secondary to get additional money as it would be paid in full.
"if the 2ndary has a higher allowance can they legally keep the difference?"
Secondary doesn't pay until pri**** is paid and eob is submitted with claim.
So doctor would be paid based on the balance left per the pri**** eob.
Do both your insurance carriers know you have another insurance? If not then the doctor could get overpaid.
Answer
The secondary carrier is not going to pay without proof of what the pri*m*a*r*y carrier paid, in any case.
Answer
The secondary carrier is not going to pay without proof of what the pri*m*a*r*y carrier paid, in any case.
Exactly, the only thing the secondary ins should be picking up is your co-ins or co-pay. That is what the coordination of benefits is for.
Answer
Why Is This Posted Twice?
Answer
Okay, the question leaves me wondering and reading between the lines. The answers given are absolutely correct, but I'm wondering what the ultimate question is. Although I am just guessing, I would like to clarify the situation. I'm guessing that a provider is billing you for an amount that is higher than the pri**** paid / allowed due to the secondary's contract. But it was not paid by your secondary because the secondary believes it to be a contractual adjustment. If that is the case, request from the pri**** payer to validate that any contractual adjustments (per their contract with the provider) are not balance billable. If so, you are not responsible for the difference. This is an issue with the provider more than likely, rather than either of the insurers. Or, are you wondering if that difference could belong in your pocket: i.e. the secondary allows more but the provider should be paid in full. The answer to that is a definite no. The best you can expect is that your expenses be paid in full (although that is not likely with the best of coverages). You cannot profit from the situation. lkc15507