by Guest » Tue Jan 13, 2009 02:09 pm
Hi. I was wondering--if you are covered by more then one health insurance policy, is it ever possible that you would get less reimbursement then if you were covered by just a single individual policy?
Here's my situation: My wife's current insurance allows in-network specialist visits, which she uses frequently, without a referral with a small ($20) co-pay. I may be able to also get her covered by my insurance for basically free, which would then be secondary to her current insurance. My insurance covers everything completely, but has a very annoying, arduous referral process which she would probably skip since she has to go to this specialist frequently.
What I am wondering is this--without the referral my insurance (which would be her secondary) would likely not pay anything for the specialist appt. Would her current primary insurance (which currently covers everything except a $20 co-pay) be able to say that they won't cover the specialist appt. fully because her secondary insurance should have paid some, and that she should have gotten a referral from the secondary insurance before the appt?
Thanks a ton!
Here's my situation: My wife's current insurance allows in-network specialist visits, which she uses frequently, without a referral with a small ($20) co-pay. I may be able to also get her covered by my insurance for basically free, which would then be secondary to her current insurance. My insurance covers everything completely, but has a very annoying, arduous referral process which she would probably skip since she has to go to this specialist frequently.
What I am wondering is this--without the referral my insurance (which would be her secondary) would likely not pay anything for the specialist appt. Would her current primary insurance (which currently covers everything except a $20 co-pay) be able to say that they won't cover the specialist appt. fully because her secondary insurance should have paid some, and that she should have gotten a referral from the secondary insurance before the appt?
Thanks a ton!
Posted: Tue Jan 13, 2009 02:25 pm Post Subject:
Would her current primary insurance (which currently covers everything except a $20 co-pay) be able to say that they won't cover the specialist appt. fully because her secondary insurance should have paid some, and that she should have gotten a referral from the secondary insurance before the appt?
No they wouldn't/couldn't...I've been in this situation most of my adult life. My husbands health care benefits have always been 'better' (and less expensive) than my employer, so for me it is better to refuse my carrier and go only with his. There was an employer I worked for however for ten years that required me to have their coverage, so they were primary and my husbands secondary. As a secondary coverage (in my case) it was WAY more of a hassle than it was worth and believe it or not I saw no benefit...by the time each did their calculations on a claim, I ended up the same or worse than when I only had the one! Now this was from 87-98 so things could have changed certainly in the past 11 years....But for me...using his coverage and his alone was the better fit..Posted: Tue Jan 13, 2009 02:49 pm Post Subject:
I see on (renewal or update) forms for my hubby health insurance that they specifically asl if there is another insurance provider that can supply benefits. If you are offered benefits from your employer and turn them down can your hubbys insurance refuse to cover you?
Posted: Wed Jan 14, 2009 02:13 am Post Subject:
If you are offered benefits from your employer and turn them down can your hubbys insurance refuse to cover you?
Never happened in my case (31 years and running :wink: )Posted: Fri Jan 16, 2009 08:29 am Post Subject:
If you are offered benefits from your employer and turn them down can your hubbys insurance refuse to cover you?
Why would you turn down the coverage that you are receiving from the insurer? Also i guess that you can prefer one coverage over the other , i.e. if your husbands policy offer more powerful network of physicians with little co-pay, you can choose their coverage over the one you have. They wouldn't turn you down.
Posted: Fri Jan 16, 2009 08:34 am Post Subject:
if your husbands policy offer more powerful network of physicians with little co-pay, you can choose their coverage over the one you have. They wouldn't turn you down.
Is that so? wouldn't there be a primary coverage and a secondary coverage? and you have to go by the primary coverage provider first?
Lori, under what circumstances you can use the secondary coverage as your primary? Can I have both the providers paying for the same medical expenses?
Posted: Fri Jan 16, 2009 12:23 pm Post Subject:
Is that so? wouldn't there be a primary coverage and a secondary coverage? and you have to go by the primary coverage provider first?
You can't in the/my situation there is no primary or secondary because I refused 'my' companys policy and went with my husbands which provides better coverage...so that is the only policy...if i were insured with 'my' employers policy and my husbands then my employers policy would always be primaryLori, under what circumstances you can use the secondary coverage as your primary? Can I have both the providers paying for the same medical expenses?
Posted: Fri Jan 16, 2009 06:34 pm Post Subject:
Thanks for the comments all. There may have been a little confusion--what I am wondering is if my wife is covered by two different insurance policies, policy A requires no referrels and policy B requires crazy referrals, can policy A deny part of the coverage because the patient didn't go out of their way to attain the referrels required to have policy B pay part?
Posted: Sat Jan 17, 2009 02:29 am Post Subject:
Nik, I'm sorry I didn't understand this was what you wanted...
Thanks for the comments all. There may have been a little confusion--what I am wondering is if my wife is covered by two different insurance policies, policy A requires no referrels and policy B requires crazy referrals, can policy A deny part of the coverage because the patient didn't go out of their way to attain the referrels required to have policy B pay part?
To answer your question NO, policy A (primary) will not change or alter their guidelines to reflect policy B (secondary policy)I know other people at work, not same employer as me but in the same building that opt out of medical, they take the pay instead and they are on their spouses insurance. I am not sure that it is really an option, but they do it, I don't know how much they actually check it out if you have another insurance available or not.
This is exactly what i do, only amount to about 20 bucks a month, but i use it to buy life ins. on husband, up my life ins, and buy AFLAC so for me it ends up costing more than the allotment anyway
Posted: Sat Jan 17, 2009 06:35 am Post Subject:
To answer your question NO, policy A (primary) will not change or alter their guidelines to reflect policy B (secondary policy)
That was quite what I'd known till now...but its interesting to know if any of you have ever had an experience where the payout of the primary policy was dependent on the secondary one. Any instances?
Posted: Sat Jan 17, 2009 06:46 am Post Subject:
You can't in the/my situation there is no primary or secondary because I refused 'my' companys policy and went with my husbands which provides better coverage...so that is the only policy...
So, you let the other policy lapse or just didn't enroll for it?
if i were insured with 'my' employers policy and my husbands then my employers policy would always be primary
So, you have to meet their policy terms first to get the coverage.
In case of the OP the primary policy has no referral system when the secondary policy requires it. So, if the OP decides to go by the primary policy's rules and doesn't meet the referral criteria of the 2nd plan, would the secondary policy still cover him?
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