Primary Insurance

Students will complete the following scenario as an essay. As you are completing your audits you observe Mary Johnson’s chart and notice the following: Mary Johnson saw Dr. Nichols today for a well-woman exam.

 

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Total charges are $185.00. Mary has two insurance companies: Primary Insurance Secondary Insurance BCBS Cigna Health CareCopay: $25.00 Deductible: $200.00 (already met)100% benefit after copay80% benefit after deductible Allowed amount: $150.00Allowed amount: $125.00Both claims were submitted at the same time in error.

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Money collected from the patient: $0.00Complete the following questions providing rationales for your responses: How much money did Dr. Nichols receive? How much should BCBS have paid? How much should Cigna have paid? How much is this claim overpaid?

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Who overpaid on this claim? What would be your next steps? Address how this situation might be avoided in the future: be specific and provide steps. The well-woman exam showed this patient due to a family history of cancer would benefit from BRCA genetic testing and both insurance companies denied this claim.

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Format a letter of appeal or BRCA testing. This assignment is completed as an APA style paper and should be at least 2-3 pages in length. Demonstrate your business knowledge and professional ethics in your response. Assignment Expectations:  Length: answers must thoroughly address each question in a clear, concise manner; complete answers will likely take 2-3 pages Structure: Title and reference page required address each question in a numbered list References: References required to be cited if used

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