Coordination of Benefits
When a member has other health insurance, whether it is Medicare, a Medicare HMO or a commercial carrier, Mercy Care will coordinate payment of benefits. These other insurers are considered the primary payer, and Mercy Care is the secondary payer.
As a secondary payer, Mercy Care will pay deductibles, co-insurance and co-payments for AHCCCS-covered services up to the lower of our fee schedule or the Medicare/other insurance-allowed amount. Here are some steps to follow to help you understand how this works:
- Determine the lowest allowed amount (or fee schedule). Is it Mercy Care’s or the other carrier?
- Subtract the primary carrier’s payment from the lowest allowed amount.
The balance due from Mercy Care is the answer to Step #2. If the difference is 0 or a negative amount, Mercy Care has no financial liability.