Q&A: Billing a secondary insurance company

January 22, 2010

Get your questions answered on secondary insurance billing.

Q: Is a medical practice that has a contract with a patient's primary insurance company obligated to bill the patient's secondary insurance company? Also, must a practice accept what a secondary insurer chooses to pay, whether or not it has a contract, if the secondary insurer decides that the primary insurer already has paid an appropriate amount?

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. If the physician does not have such a contract, then he or she may be able to give the patient a copy of the bill and have the patient submit it for reimbursement.

Send your practice management questions to mepractice@advanstar.com. Answers to our readers' questions were provided by Judy Murray of Clayton L. Scroggins Associates, Cincinnati, and Steven I. Kern, JD, of Kern Augustine Conroy and Schoppmann, Bridgewater, New Jersey.