Right now I’m really upset so please bear with me if I ramble. Here is the issue you must watch out for. Apparently Blue Cross has decided it was paying us wrong when it came to it as a secondary.
Here is an example: You bill the primary $100, the primary adjusts the charges and has a allowable of $50. It pays you $40 and passes the co-payment to the patient of $10. Your biller sends the $10 to the secondary (Blue Cross) who states is allowable is $45 therefore they only pay the difference, What the primary paid minus their allowable--$5. They say in some cases you must collect the remainder from the patient, in some cases, you can’t.
In the above case, if the secondary was $20 or $30 above the primary , you would only get the $10.
If this is not bad enough, I had a patient today who was on a generic medication, his cost was $7 which was paid for by his secondary, He just found out that his secondary, (Blue Cross) would only pay up to it’s allowable and the patient now has to pay the rest.
What is going here???? Have others noted this trend??? When did this new policy start?? (the rep at Blue Cross could not tell me.
This may sound like a small issue but a promise to us and a promise from the secondary’s to pick up the co-pays or the drugs is a promise.
Give me your ideas or thoughts. Kim, if you like, post this on the Blogg. I don’t know how many people have signed up yet.
John Bossian
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2 comments:
I had a little trouble following the payment trail. John's post seemed to suggest that Blue Cross made money on the deal. They got the $10 copay and only paid out $5. Is this correct?
Sarah
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