I’ve had Medicaid as my primary for years but recently got Anthem added as a coinsurance through work. It’s my understanding that Anthem is now primary payor and Medicaid is now my secondary. I recently got a text regarding an ER visit from 2025. The claim was initially paid by Medicaid but now they’re trying to bill me for the entire amount since Medicaid has apparently denied it after the fact due to my Anthem. I know this should be easily resolved by calling billing and giving them my Anthem info. I’m just curious if this is normal. I’ve only had Anthem for about six months and just wondering if a payment reversal is normal and if so how often can I expect to get these?
Recently got consonance. Now my primary is rejecting a paid claim from last year. Is this normal?
byu/PersonalAnswer8664 inInsurance
Posted by PersonalAnswer8664
2 Comments
Edit: That should read coinsurance, not consonance.
Yes, this can happen. It’s usually a coordination-of-benefits cleanup issue, not some weird one-off. Once a provider or Medicaid finds out there was other coverage that should have been primary, they can reverse the old payment and kick the claim back to be billed in the right order. That does not automatically mean you truly owe the full ER bill. Most of the time the provider needs to bill Anthem first, get Anthem’s explanation of benefits, then bill Medicaid secondary if Medicaid still applies. I’d call the provider’s billing office, give them the Anthem info, and ask them to pull the account out of patient-pay status while they rebill it.