Question

Instructions

1. Read the Case Study Physician Medical Billing found in Chapter 11, page 237 of the textbook:
   
   William arrived at Dr. Spence’s office and gave the medical office specialist his insurance cards. Recently, William’s wife had gone back to work, and they now had two insurance plans. The front desk assistant asked William which insurance was primary. William did not understand the question. It was explained that it meant which insurance was to be billed first. William asked that his wife’s be billed first because it had better coverage. The medical office specialist explained that his insurance would have to be billed primary and his wife’s secondary.
   
2. Afterwards, answer the following question:
   • Why can’t his wife’s insurance be primary?
   • What would be the result of billing the wife’s insurance as primary?
   • Will there be cases when the spouse’s insurance may be primary?

Answer 1

1. William’s wife insurance couldn’t be primary because there is some criteria which has to be followed by the authority and insurance company as well as the clients. Williams would be the primary source of insurance here because who pays the premium is considered to be the primary one and also date of birth matters, in couple cases, elder should considered as primary. So, here Williams’s wife is considered as secondary insurance.

2. It is not possible if payment is still in the primary insurance card, but if there is no payment left in primary coverage then secondary will considered.

3. Yes, spouse’s insurance considered as primary when they are paying the payment of insurance coverage otherwise they are considered as secondary insurance.

answered by: anonymous