Back in the day, I worked for an educational institute where we had 2 medical insurances.
One was provided by the institute (employee paid premiums) and one through an employee union (union member paid premiums).
So if I went to my doctor with pneumonia, I submitted my claim to both insurances. I did not pay a cent out of pocket. I was paying two premiums and expected and got double coverage.
Today it seems like I cannot do this. My wife and I pay two premiums because we both have medical coverage at our respective jobs. Why is it anyone’s business that we have double coverage? Why is one now a primary and the other a secondary? Sounds like this gets the secondary off the hook for full payment even though they get full premiums.
Extrapolating this, if I’m willing to pay 10 premiums, why can’t I have 10 coverages and actually make money if I make a claim?
What am I missing? Did the lobbyists get things changed?
Note: I should add that we are paying 2 premiums for family plans, not individual coverages.
OP here: I might add the inconsistency of this policy. If you have two separate life insurances policies and you die, both pay in full, one doesn’t get to say “oh your family was paid already for your death by company A, we’ll give you a fraction of your policy value”. So why should medical (or dental) insurance be different?
I think that’s the question, sometime between the 80’s and now, having double coverage went from being awesome to being a waste of money. How and why was this possible?
It’s possible because there’s no law against it. As employers sought to reduce their costs, they agreed to policies with “coordination of benefits” clauses in them and soon they became the norm.
If you want to make a profit on your hospital stay, sign up for AFLAC (the one with the duck).
If I remember right, they chose the primary insurance based on month of birth. The primary paid until they hit their limit. Then the secondary paid off the remainder of the bill. You pretty much never had to pay out of pocket.
There was a time when there were no networks or preferred providers or anything like that. Your doctor did not get involved with your insurance. The doctor sent you an honest bill – not the inflated fictional bill they send today – and if you had insurance, you filled out a form and sent it with the bill to the insurance. You paid the doctor and the insurance paid you back whatever you were covered for. Simple times.
Not sure about the land of the “Free” and home of the Brave. here in Canada, major medical is covered by Universal Health Care, no money out of pocket. My wife and I both have insurance benefits through our employer - covers things like prescriptions, glasses, dental, chiropractic, massage therapy, orthotics, etc.
The way it works if you both have coverage; for each of you, your employer’s insurer is primary. The insurer will pay whatever they cover - say 80% of the cost of prescription or chiropractor, up to an annual maximum. Whatever the primary insurer did not cover, the secondary (spouse’s benefit) covers up to max 80% of total cost-i.e. the next 20%. As a result, things like dental end up being zero out-of-pocket even though each policy only covers a fraction. Some practitioners direct-bill, others make you pay and you submit the receipts (first to primary, then to secondary with proof/receipt that primary has paid their share.)
At no time do you come out ahead with extra cash; and all benefits submissions ask “is this covered by any other plan? How much did they pay?” and consider any patient’s coverage to be primary and spousal policy to be secondary. Presumably the big insurance companies compare details to catch people trying to game the system.
I suppose the other fun question you have to ask - if I have a $2000 annual deductible, does this count toward both policies? Or does the “meter” on the second policy only start counting deductible when the first one’s $2000 is fully paid? In which case you may never reach the point of paying both off unless you grossly exceed what the first one covers…
But health insurance essentially says “we will pay the bill”. If the resultant bill after the other insurance has paid is $0 then the second insurance does not need to pay anything. If the second policy says “we will pay 80% of the bill”, and the secondary says “we will pay up to 80% of the bill minus whatever the other company paid” then the question is - what does the fine print really say? That they won’t cover the last 20%? Or they will pay up to the remaining bill or 80% of the total, whatever is less…?
OP here. I thought long and hard and remembered that could not make money but I didn’t have to pay anything out of pocket after all was said and done. Like I said I had two policies. One paid 80%, no deductible. I would then submit the balance to the other and they covered it entirely. And this made sense, I was paying for two policies; they should have been and were independent.
Now my current situation is actually dental not medical but the concept holds.
Both our jobs had reasonably priced family plans. Unfortunately my wifes policy had a lower annual cap. If we needed any premium service, like a crown, you could get soaked with just one policy. So we opted for double coverage. Problem is that unlike the old days, the second insurer is not paying the balance, only a percentage.
I don’t know just when it all changed, but when the kids were young we too had double insurance. Mine was the better plan (through my work); we kept my husband’s coverage on the family as well because it was free. So primary would pay its 80%, and secondary would pay its 80%… except they’d deduct the amount already paid, so they’d just pay the remaining 20%.
Some time when the kids were past toddler age they changed. Primary would pay 80% (or the negotiated rate or whatever), secondary would say “we’ll pay x dollars - oh look, primary already paid that, so screw you!!!”. It was extremely rare that secondary covered anything that primary hadn’t already covered, so the secondary coverage was a complete waste of money.
Not to mention the hassle of submitting to secondary; we’d have to file with primary, then mail the EOB plus a claim to secondary - who would often bounce it back to us for no more reason than “they felt like it”. Especially fun when both insurances were through NY Life (later NYLCare; we took to referring to them as DeNYLCare). The secondary would almost always look at it, say “ooh, this other office is primarhy” and send it to the other location, who would say “Derrr, we already PAID this” and deny it.
It got to the point where I NEVER submitted a claim to secondary without a cover letter explaining exactly what was going and and “please do NOT send it to this other office - as you can see from their EOB, they already did their part”.
We do maintain double dental coverage, as both my husband and I tend to have pricey dental work done, and both our insurances have a 2K a year cap. So we’ll run out the limit on the 2K, then subsequent claims to primary are of course processed as “we’ve paid the limit, so we’re not paying on this one”. We then run those through secondary.
They seem to have ways of finding this out. We will occasionally get notices from insurance asking us to verify that we don’t have other coverage. I imagine it would be considered fraud if we submitted the same claim to both and lied about it to get reimbursed more than the bill was for.
But I do think it’s scammy that the secondary won’t pay anything. They’re basically taking your money and refusing to provide the “service” they’re paid for (and I use the word “service” in the same way a cattle breeder talks about a bull “servicing” a cow).
I’m not sure about the exact mechanics of “double insurance” in the 1980s, but it is generally held to be against public policy to profit off of an insurable loss as it creates a moral hazard.
It seems to me(and I could be wrong) that this practice started with medicare in the US. If I’m remembering correctly, there was a minor uproar over medicare starting this as a money saving policy, your private insurance paid first then medicare picked up some percentage of the remainder. I want to say it was supposed to be related to means testing for benefits somehow, but I’m not certain. I failed to find anything directly
related in any of the searches I did
When my wife and I were employed we both had insurance at work. The primary paid their share and then the secondary pick up the rest until its limit was reached.
Say a doctor charged $200 for a procedure.
The primary’s coverage was $130
The secondary’s coverage was also $130.
Primary paid $130 secondary paid $70. The doctor billed the insurance companies and they paid the doctor.
Our last job both employers offered Kaiser. Doctor offices and meds cost to me was $10 per. But where we had dual coverage we paid nothing. And there were other services that cost us nothing, but were listed as having a charge. My CPAP machine $0.00 as an example.