Question

If a patient has both Medicare and Aetna, which insurance do you bill?

1) Medicare first, then Aetna. Medicare will send an RA to Aetna for COB
2) Aetna first, then Medicare because private insurance should always be billed first
3) Determine which insurance is primary and bill that first
4) Check the patient's insurance card for instructions

Answer 1

In most cases, Medicare is billed first as the primary insurer, followed by Aetna as the secondary insurer. The coordination of benefits is managed after Medicare has processed the claim.

Step-by-step explanation:

When a patient has both Medicare and a private insurance plan such as Aetna, the primary insurer should be billed first. In most cases, Medicare is considered the primary insurer, especially for those who are eligible for Social Security benefits. After Medicare processes the claim, an Explanation of Benefits (EOB) or Medicare Summary Notice (MSN) is sent to the secondary insurer, which in this case would be Aetna. Aetna will then process the claim considering what Medicare has already paid and may cover some of the remaining costs as per coordination of benefits (COB).

The correct steps involve billing Medicare first, then Aetna. You would not bill Aetna first or look for instructions on the patient's insurance card to determine the billing order. Instead, determine the primary insurance, which is typically Medicare for eligible individuals, and process billing accordingly.