billing with two insurances

If a patient's primary insurance has a contracted rate for certain procedures (ie. office visit -99214 and refraction- 92015) and there is a secondary insurance that gets billed(in this case- by the patient) for overlapping procedures, do I refund the full amount to the secondary insurance for the overlapped procedures or can I collect payment for the difference of what the primary insurance paid?

re: billing with two insurances

This depends on your contracts.

Ex. 1 Medicare Allows CPT® 99214 $100.00

Secondary: Amerigroup - Your contract states 120.00 for CPT® 99214.

If Medicare pays 80%, which is $80.00, then your secondary should pay up to your contracted rate.

Which is $120.00, so Amerigroup would owe you $40.00.


Ex: 2 Medicare allows CPT® 99214 $100.00

Secondary: Medicaid, they allow for CPT® 99214 50.00

Medicare pays 80%, which is $80.00, Medicaid does not pay anything because Medicare paid more

than Medicaid's allowable.

Hope this helps!!