Maria Santiago brought her daughter Jessica, age 17, to the office with the chief complaint as back pain. Maria indicates that Jessica was in a car accident 30 days ago while driving to school with friends. Maria tells the doctor that Jessica has been seeing a chiropractor for a month, however, the pain has not subsided. Maria asks if there is a pain medication the doctor can prescribe to reduce Jessica's pain. At the end of the visit Maria paid a $20.00 copay and received a prescription for Naproxen for Jessica. The billing department submitted the claim for the visit to Blue Cross Blue Shield (BCBS) as the primary and Aetna as the secondary. The primary insurance (BCBS) indicated an allowed amount of $560.00 and paid $520.00. The bill was then forwarded to Aetna. Blue Cross Blue Shield later denied the claim and requested the funds be returned stating the patient was covered by another insurance at the time of service. The billing department then contacted Aetna who denied the claim for the same reason. Please explain what could possibly have gone wrong. How do you fix it?

Answer rating: 100% (QA)

Answer Coordination of benefits COB occurs when a patient has multiple insurance plans and each plan ... View the full answer