Review the following case study and determine the necessary action to be taken. Mary Johnson saw...

Review the following case study and determine the necessary action to be taken.

Mary Johnson saw Dr. Nichols today for a well-woman exam. Total charges are $185.00. Mary has two insurance companies:

Primary Insurance Secondary Insurance

BCBS Cigna Health Care

Copay: $25.00 Deductible: $200.00 (already met)

100% benefit after copay 80% benefit after deductible

Allowed amount: $150.00 Allowed amount: $125.00

Both claims were submitted at the same time in error.

Money collected from the patient: $0.00

1. How much money did Dr. Nichols receive?

Solutions

Expert Solution

Irrespective of the insurance policies held by Mary Johnson and the copay component or the deductible, Dr. Nichols would receive the total charges of $ 185 billed to Mary.

$ 185 would come from different sources be it the insurance companies or the patient (Mary) herself.

Hence, Dr.Nichols would receive his full amount of $ 185.0

keosha answered 1 year ago

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