Billing Secondary Insurance

You may have clients who have health insurance coverage via multiple insurance plans. Why might your client be covered under two plans? One reason may be they have primary insurance through their own employer, and secondary coverage via their spouse’s or partner’s insurance plan. They may also be a dependent under another person’s plan. Your client’s primary plan may be Medicare, which covers nutrition counseling for diabetes and renal disease. Their secondary plan, then, is likely one provided by private insurance. Or your client may have secured coverage under two private insurance plans due to having two employers – one serving as their primary and the other as their secondary. Clearly, there are myriad reasons!

When you bill your client’s primary insurance, you may learn that your client is not fully covered. Hence the importance of first having Healthy Bytes conduct an eligibility estimate to prevent such surprises! Your client’s primary plan may inform you that they cover 80 percent of your client’s visit, for example. If and when you learn that your client is not fully covered by his/her primary plan, you may bill his/her secondary health insurance plan for the remainder of the amount due.

Here’s another example. Let’s say one’s primary plan covers three visits with you, the RDN. The secondary plan may cover 12 nutrition counseling visits – hence, you’re able to bill your client’s secondary plan for any visit after his/her third visit with you. Medicare may cover diabetes and renal disease visits, but bill your client’s secondary insurance (if they have one) for all other diagnosis codes. Lastly, one’s secondary insurance may cover items such as co-pays or co-insurance deductibles, whereas your client’s primary insurance may not.

What is all boils down to is having Healthy Bytes conduct that oh-so-important eligibility estimate from the start, before you have your first visit with your client. Make sure your client onboarding process includes inquiring whether they have a secondary insurance plan. If they do, provide us with this information when you're adding a new client to your Healthy Bytes dashboard so that we can conduct an estimate for the secondary at the same time that we do one for the primary. And if this slips past you and you find out after the fact that your client has a secondary plan that he/she wishes to bill, provide us with the Explanation of Benefits from the primary carrier and we can handle the claim from there!

 Are you billing your clients’ secondary insurance plans? What has your experience been like?