Hello,
We are having some fits at the office because we apparently don't understand how the coordination of benefits works when a patient has two insurances. Lets use this example:
Our fee for a crown is $1000. Delta allows $596. Cigna allows $968. We are in network with both. The husband has cigna as primary and delta as secondary. Cigna paid 50% of $968, or $484. Delta will only pay the difference of their fee and what Cigna already paid ($596-$484 = $112). So, we received a total of $596. At this point, we typically write off all of the difference from our fee and the received $596. I assume this is correct? On the EOB from the secondary insurance, Delta, it states that the patient portion is $0. Delta is supposed to have "Standard Coordination of Benefits."
The wife has Delta as primary and Cigna as secondary. On the exact same crown, Delta will pay 50% of their fee ($596), or $298. Cigna paid 50% of their fee ($968), or $484. Here, we received a total of $298 + $484 = $782. But, the Cigna EOB states that the patient portion is the difference from their fee ($968) and both insurance payments combined ($782). $968-$782 = $186. Meaning, we collect Cigna's (secondary insurance) full fee. Cigna is supposed to have "Non-Duplication Coordination of Benefits."
Does this sound right to you? How do you give a patient an accurate estimate when they have two insurances? The family isn't understanding how the wife can owe $168 for a crown and the husband owes nothing. I appreciate your help!
We are having some fits at the office because we apparently don't understand how the coordination of benefits works when a patient has two insurances. Lets use this example:
Our fee for a crown is $1000. Delta allows $596. Cigna allows $968. We are in network with both. The husband has cigna as primary and delta as secondary. Cigna paid 50% of $968, or $484. Delta will only pay the difference of their fee and what Cigna already paid ($596-$484 = $112). So, we received a total of $596. At this point, we typically write off all of the difference from our fee and the received $596. I assume this is correct? On the EOB from the secondary insurance, Delta, it states that the patient portion is $0. Delta is supposed to have "Standard Coordination of Benefits."
The wife has Delta as primary and Cigna as secondary. On the exact same crown, Delta will pay 50% of their fee ($596), or $298. Cigna paid 50% of their fee ($968), or $484. Here, we received a total of $298 + $484 = $782. But, the Cigna EOB states that the patient portion is the difference from their fee ($968) and both insurance payments combined ($782). $968-$782 = $186. Meaning, we collect Cigna's (secondary insurance) full fee. Cigna is supposed to have "Non-Duplication Coordination of Benefits."
Does this sound right to you? How do you give a patient an accurate estimate when they have two insurances? The family isn't understanding how the wife can owe $168 for a crown and the husband owes nothing. I appreciate your help!
