Determine which insurance is responsible for payment

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Determine which insurance is responsible for payment.

1. A 35-year old female presents to the ER with a chief complaint of pain in the left shoulder. A comprehensive examination reveals a torn ligament. The patient indicates the injury occurred while lifting a vacuum cleaner at work. The patient is a teacher for the neighborhood elementary school. The insurance card presented is United Healthcare medical. Please determine if this is the correct insurance for claims submission. Why or why not?

2. A 62-year old man presents to the office with a chief complaint of shortness of breath, chest pain, and constant chest congestion. The patient claims he has felt this way for 10 years, but it worsened when he retired from the coal miners' industry. He presents to the office with a Medicare card and Medigap. Please indicate if the Medicare and Medigap are the correct plans for his condition. Why or why not?

3. A 22-year old male presents to the observation unit complaining of severe lower back pain when urinating. The patient also states that due to his ESRD he notices blood in the urine. He stated the doctor diagnosed him with the condition when he was 19 years old and has been on dialysis and medication since then. The client presents with Blue Cross Blue Shield, a Medicare card, and a Medicaid card. Please indicate which insurance is primary. Why? Which insurance is secondary? Why? Which insurance is tertiary? Why?

Reference no: EM133843168

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