My husband has individual health insurance through his job (his primary insurance). He also has a separate health insurance plan (from a different provider) that we pay for through my job. This is a result of us not getting around to canceling him from the secondary plan after he got his job.
Generally he has been providing his primary insurance to providers. They generally cover most of the cost but there is always a "co-insurance" amount listed in the EOB
that the provider ends up billing us for. We pay it- then we submit a claim directly to his secondary insurance who then pays us that full "co-insurance" amount.
Recently we thought it might be easier to just give the healthcare provider information from both insurance plans and let them do all the billing. On a recent urgent care visit this resulted in the urgent care clinic billing BOTH providers for the full visit amount ($438). Both providers payed a negotiated discounted rate and had a leftover "co-insurance/patient responsibility" amount. The provider then billed us for the lesser of those two amounts ($48).
I am nearly 100% confident that had we just provided the primary insurance coverage (which had the $48 leftover 'co-insurance' amount) and then sent a claim in ourselves to the secondary insurance for that $48 they would have reimbursed us the $48 (that is how we had been doing it before this case).
My question- Is is appropriate for the clinic to be billing both insurance companies for the same amount/service, and accepting a negotiated payment from each of them without the other knowing? And further billing us for one of the remainders?
In this case they billed $438 to both providers. From the primary insurance they accepted an adjusted amount of $188 for which the insurance payed $140. From the secondary insurance they then accepted an adjusted amount of $120 with an amount of $65 as "not covered" as indicated by the secondary insurance EOB
. They are now billing us for $48 (seemingly the amount listed on the primary EOB
Sorry if this is totally confusing (it is for me too!).