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Billing Primary and Secondary Insurance For A Minor

Kali 1 year ago in Billing/Electronic Modules updated 1 year ago 11

This is a sticky situation, but does this happen to any other agency, and how do you direct/navigate the guarantor to resolve these issues?

Client is a minor whose primary insurance is through biological father, secondary insurance is through MN Medical Assistance.  The primary insurance through biological father lapsed, and we’re told there is no way to contact biological father to verify primary benefits or inquire.  If we send the claim to MN Medical Assistance, they will deny because they have biological father’s insurance on file as a Primary.  Feels like we are stuck.  How do you get the wheels moving forward on this?

+1

If you can verify primary insurance termed via the payer portal, ie Availity, you can then do this (pasted from MHCP billing manual), I've done this a few times since I found this and it worked. Once I got a fax back from DHS showing the received the info and I guess updated it in their system, the other time I did not get anything back so I resent claim to MA hoping it was updated, and I think this one paid as well: http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS16_146872#bill_codes

Report Health Insurance Effective and Termination Dates

Notify DHS of health insurance terminations and denials for people not covered by the policy. Send a copy of the termination notice or denial, or document on your office letterhead all of the following information:

  • • Member name
  • • Member MHCP ID number
  • • Insurance company name
  • • Termination date
  • • Whether the termination applies to the policy or individual
  • • Name and phone number of the person contacted to obtain the termination information
  • Fax (preferred):

    651-431-7431

    Mail:

    DHS Benefit Recovery Section
    PO Box 64994
    St Paul MN 55164-0994

    @Crystalp -- This is very helpful.  Thank you!

    +1

    We usually inform the custodial parent to resolve the issues or the balance would become private pay as it is not being covered.

    Clients are required to understand their own insurance.

    While you may not contact the dad, Mom would have resources either directly or through a laeyer. Mom could also notify her case worker of the issue and let the county resolve the issue.

    If the minor client's second insurance is MN Medical Assistance, can you charge the client as Private Pay?  I'm almost sure this is against MN Statues for Mn Medical Assistance.  I could be wrong.

    I didn't think we could bill clients/parents either in this type of situation when they have an active MA plan. The letter is a good idea.

    +1

    Hey Kali, 

    I would suggest familiarizing yourself with the information available on this page of the MN DHS Provider Manual. It covers the situations in which a client with MA can be charged and what requirements need to be met.

    Thanks Ashley!  I've read through this information on several occasions.  Thank you for posting this!

    We send a letter to the address on record explaining that they must contact the insurance company (by calling the number on the back of their card) and also that we cannot send the claim on to other insurance until this occurs.  And that we will bill the client until it is taken care of.  That gets it done.  Our financial agreement that is signed by a parent states that whomever signs it is ultimately responsible for the bill, even if they have a court agreement about who pays what portion of things.  We have nothing to do with their divorce, the agreement is between the court and those two parties.  That has saved us a ton of hassle.  

    Good luck.  

    Well said, that is the longer version of what i was trying to get to :)

    Marsyl could you send me a copy of that letter? I would like to review and modify for use, if you would allow.

    I will double check but if they are denying it.....

    We primarily use the letter primarily in the case of two commercial insurances, but when MA or a PMAP is denying for updated coordination of benefits, then we have few options so we send the letter explaining why MA isn't paying.  We also note it in the file so that the practitioner can explain it to the client if need be, as we all know how "confusing" insurance can be.  It has been very effective in getting folks to make the call when they realize the request is in their own best interest, and that we cannot do it for them.  

    Also, we have a policy that if a balance gets above a certain point, we may need to discontinue services.  In other words, if we are not getting cooperation, we will not just keep seeing the client and 'hoping for the best.'  

    Mark, how would I send a copy to you?