by elizabeth.gowens » Mon Sep 13, 2010 02:59 pm
My son is covered under both my husband's and my health insurance plan. Both plans have the same individual deductible of $500 but my husband's who is primary (because of the birthday rule) pays 80% coinsurance amount while my plan pays 90% coinsurance. The bill will be about $7000. Is it better for him to be on both plans or just one plan? If we use both plans do we end up paying for both deductibles out of our pocket? Thank you.
Posted: Mon Sep 13, 2010 10:47 pm Post Subject:
Both plans are subject to the deductible, but your actual out of pocket expense should be credited against both deductibles as well. That's a question for the secondary insurance company to answer -- as that situation may be covered in the contract.
Can't tell you if it's best to have your son on only one plan. The fact is that when covered by two plans, it's possible to have 100% of the bills paid (after the deductible, of course). You would submit the claim properly to the primary insurer, then the unpaid balance to the secondary insurer. To the extent that the secondary insurer would pay the same bill if it were primary, it will pay as secondary, even though it is 90/10 coinsurance. If the unpaid amount is less than the 90% the company would be liable for, it will pay 100% of that amount.
You just cannot collect 80% from one and 90% from the other by submitting a "Paid" receipt for the full amount to both insurers, and collect 170% of the bill.
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