How does billing secondary insurance work?
Asked by: Rosendo Sporer | Last update: December 6, 2025Score: 5/5 (46 votes)
What is the process of billing a secondary insurance company?
Once you're ready to bill the claim for the patient's appointment or services, submit the claim to the primary insurance plan. After the primary insurance processes the claim, note the allowable amount, the patient responsibility and any adjustments. Submit the claim to the secondary insurance.
How does secondary insurance coverage work?
Secondary insurance is when someone is covered under two health plans; one plan will be designated as the primary health insurance plan and the other will be the secondary insurance. The primary insurance is where health claims are submitted first.
Are providers required to bill secondary insurance?
They either pay the coinsurance or they leave it as patient responsibility. When it comes to obligation, it's a courtesy to file secondary if the provider is not credentialed/contracted but in the case were the provider is contracted with the insurance then he/she is contractually obligated to file the insurance.
Can you bill 2 insurances at the same time?
If you have a primary and secondary health insurance, your bill will not be given to both of them at the same time. Your primary insurance will typically be billed first unless there is a rule under your Coordination of Benefits provision that decides which insurance pays first.
Billing Secondary Insurances
How do you determine which insurance is primary?
The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary payer. The secondary payer only pays if there are costs the primary insurer didn't cover.
Do you still pay a copay if you have two insurances?
In most cases their secondary policy will pick up the copay left from the primary insurance. There are some cases where the secondary policy also has a copay and those patients may end up with a copay applied after both insurances process the claim.
What is dual billing in healthcare?
Double billing: Companies cannot attempt to collect on medical bills that have already been paid by the consumer, insurance, or a government program such as Medicare or Medicaid. This practice can coerce consumers into paying twice for the same service, causing significant financial harm.
When a patient has a secondary insurance policy, it is billed after the primary policy has paid, true or false?
Final answer: A patient with a secondary insurance policy is billed after the primary insurance has made its payment, which is true as the secondary insurance covers the remaining cost. This collaboration between insurance policies helps reduce the patient's overall out-of-pocket expenses.
Can a provider choose not to bill insurance?
In the United States, there is no federal law mandating that hospitals or healthcare providers must bill private insurance, Medicaid, or Medicare.
What is double insurance?
Double insurance refers to the method of getting insurance of same subject matter with more than one insurer or with same insurer under different policies. This means that one can get insurance policies on a subject matter more than its value. Double insurance is possible in all types of insurance contracts.
Can I have a high deductible health plan and a secondary insurance?
Other coverage that is allowed in addition to an HDHP
The IRS does allow you to have some types of coverage in addition to your HDHP, without jeopardizing your eligibility to contribute money to your HSA.
Is secondary insurance cheaper?
Yes, cost-conscious customers can use a low-cost secondary insurance policy to save money on medical care and reduce total medical costs. Secondary plans can be as affordable as $5–50 per month.
Who pays for secondary insurance?
The "primary payer" pays up to the limits of its coverage, then sends the rest of the balance to the "secondary payer." If the “secondary payer” doesn't cover the remaining balance, you may be responsible for the rest of the costs.
Who sends secondary insurance claims?
Healthcare practices cannot submit a claim to both insurance companies at the same time. Instead, you'll need to submit to the primary insurance, wait to see how much the primary insurance will pay, and then submit to secondary insurance.
What is duplicate billing in healthcare?
Double billing also occurs when a provider attempts to charge more than once for the same service For example, by billing using an individual code and again as part of a bundled set of tests.” Double billing is also known as duplicate billing.
How does billing work with two insurances?
Your primary plan processes the insurance claim first and covers the bill up to its coverage limits. If your primary insurance is unable to cover the entire claim, your secondary insurance may cover all or a portion of the remaining costs.
When should a biller bill secondary insurance?
Once the primary claim is processed and any applicable payments or denials are received, you can proceed with billing the secondary insurance.
Can a doctor refuse to bill secondary insurance?
A: The answers to your questions depend on state law. Some states require physicians to bill all insurers a patient has, without charge, whereas others do not. If the physician has a contract with the secondary insurer, then, by contract, he or she most likely is obligated to submit the bill.
Why is double billing illegal?
Law. In law, double billing refers to charging an hourly rate to two clients for the same time spent working. The American Bar Association prohibits double billing. It is tantamount to overcharging, since the amount of time actually spent working on any one client's work is less than the amount billed to that client.
What does 2nd billing mean?
"Second billing" means someone else is getting "top billing", or more attention/credit.
What are the consequences of double billing in healthcare?
Even if someone in your office made a mistake and accidentally billed twice for the same service, an accidental error can still trigger a government investigation and charges of Medicare or Medicaid fraud.
Will secondary pay if primary denies?
It depends on which insurance is considered “primary” and which is “secondary.” The insurance that pays first (primary payer) pays up to the limits of its coverage. The insurance that pays second (secondary payer) only pays if there are costs the primary insurance didn't cover.
Which health insurance company denies the most claims?
According to the analysis, AvMed and UnitedHealthcare tied for the highest denial rate, with both companies denying about a third of in-network claims for plans sold on the Marketplace in 2023, respectively.
Does copay go to provider or insurance?
Insurance plans often come with copayments, which are fixed amounts you pay for covered services at the time of receiving care. Copays are a standard feature in many health insurance plans and serve as a way to share the cost of healthcare between you and your insurance provider.