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Lori Posted 4 month(s) ago
What do we do with the extra money if two insurance plans, both pay as a patient's primary insurance? We've attempted notifying the payers, but they each insist they have paid correctly. Please, provide supporting evidence for your reply? Thank you.
SuperCoder Posted 4 month(s) ago

This is a payer error and once the payer identifies that it has considered both insurances as primary and has overpaid by mistake, they will be recouping it from the provider.

It would be better on the part of the provider to let the insurance company know about the overpayment received so that to get it rectified at the earliest.

 

Member (Patient) can also get in touch with the insurance company and get this sorted out. Patient needs to be aware of the primary and secondary insurance provider. Coordination of benefits (COB) allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities (i.e., determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan).

 

Please find below the CMS link for more understanding.

 

https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Coordination-of-Benefits/Coordination-of-Benefits.html

Lori Posted 3 month(s) ago
Let me clarify. If we have a patient with Medicare as primary, and additionally have a private insurance plan and both payers pay as primary. Is this considered an overpayment and go to the patient legally?
SuperCoder Posted 3 month(s) ago

Yes, this would be considered as an overpayment. Provider has received more dollar value than the allowed amount in this scenario. The overpayment received by the provider will be recouped by the insurance provider once they get to know about it. Usually these things come out in audits. Once provider gets to know about it, he/she will have to pay back the overpayment amount. The patient will not get anything in this case. It would be a matter between service rendering provider (doctor) and insurance provider.  

Posted by Lori, 4 month(s). There are 4 posts. The latest reply is from SuperCoder.

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