Primary/Secondary insurance snafu

[Beartracks]

Seeking advice... I'm scratching my head at how often medical providers will screw up insurance claims when you have two insurance plans. In our case, I have ins through my employer, a Fed agency, and my retired spouse also has a Medicare replacement plan. Because she's on my fed plan, it is primary for her for medical claims; normally (that is, if my employer plan was not Fed) her Medicare replacement plan would be primary. This is a constant source of confusion for medical providers.

Anyhow, in one instance, a $3000+ surgical claim was submitted to my plan from an out-of-network provider, and my plan paid for around 30%, but they sent the check to me. I've held onto it as it was my intention to file a grievance with the insurance to see if I could get them to pay in-network rates. As other life stuff continued to happen, I never got around to doing so, although I did manage to call the provider and tell them about the secondary insurance. The provider then filed the ENTIRE amount against the Medicare replacement plan, and they paid nearly 90% of the claim!

So now I have this undeposited check for about $950 and a bill from the provider for about $310.

What do I do? Obviously the primary check will more than cover the remaining balance, but I would have to deposit it in order to pay the bill. I suppose I could pay the bill, and then send the rest back to the primary insurance, but then that would raise flags and issues between the two insurance companies as to who should have paid how much.

Any suggestions? I think keeping the extra amount wouldn't be right.

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