Dual medical insurance question

I have medical insurance through my employer. We’ll call them HealthCoA. I also have secondary medical coverage through my spouse’s employer. We’ll call them HealthCoB. I think I’ve been covered by both for about 4 years. I have never seen any form from either that I have to disclose that I have coverage elsewhere.

After I got the secondary coverage, the first time I went to a provider (probably was the dentist since that is what I use most) I said something along the lines of “I’m also now covered under my spouses insurance and here is the card”. They said “great, we’ll list them as the secondary”. Something along those lines. I thought that was how it was handled since similar exchanges happened at my eye doc and regular doc.

We just received a letter from HealthCoB. Here is what it says:

Is that the Star Wars “Imperial March” I hear?

Did we fail to do something we should’ve? Are we going to get a gigantic bill from them? And should I expect the same thing from HealthCoA? Anyone have insight into this?

In insurance, everyone wants to be secondary payer.

I have no practical understanding how they work that out, other than comical slapfights. Or both denying primary payer status and making the insured work it out.

I’m fortunate, in a way. My main insurance is Tricare Prime, and by law, it’s secondary payer if there’s any other health insurance available. However, it’s plenty comprehensive so I’m not buying any other health insurance, so nyah nyah on you, Department of Defense. :smiley:

Unless one of the plans is an HDHP with an HSA (you can’t have an HSA if you are covered under a non-high-deductible plan) you are fine. HCB is telling you that it didn’t know you also had coverage with HCA and that it’s probably going to go and argue with HCA about who’s responsible for payment. Not your problem.

That sounds promising. Are you saying it will be the two insurance companies that will be fighting over who pays for what versus me getting a bill for 4 years of care? I hope so!

And I’m not sure what an HDHP with an HSA means. I think both of these would be considered “cadillac” plans. Actually HCB might be even Rolls-Royce.

Yes.

An HDHP is a high deductible health plan. You pair them with an HSA (health savings account), which is essentially a tax-deferred account for medical expenses only. If your insurance plans are first dollar (i.e., you don’t pay a big deductible each year) they definitely aren’t HDHPs.

I’m a bit confused about the dentist part though. Did you give your health insurance cards to your dentist? Dental coverage is generally a separate plan.

Thanks for the clarification. Neither are HDHP’s and I don’t do an HSA.

  • HCB covers medical, vision and dental (they are all listed on the insurance ID card).
  • HCA covers medical and vision and while dental is slightly separate, I still use the same card. I know I am not explaining it well but it is because I don’t quite understand this system. After I go to the medical doctor, I’ll get the “explanation of benefits” form from HCA. After I go the dentist, the explanation of benefits is from a different company. I don’t have a separate insurance ID card for dental.

That’s astounding that they haven’t asked you in 4 years.

I think I’ve received about 2-3 calls/letters a year for the past 4-5 years asking me to make statements and/or sign affidavits that I have no other insurance that me or my dependents could be covered by.

Which generally irritates the piss out of me, considering that my insurance is through work, and my wife is a stay-at-home mom.

I have to return a “Working Spouse” form every year which asks questions about spouses health coverage, presumably to proactively deal with just this sort of thing.

Since this involves legal/medical advice, let’s move this to IMHO.

Colibri
General Questions Moderator

First, IANAL. I did work in insurance many years ago.

State law will specify how to determine which plan is primary. Usually insurance you get through your own employer will be primary over coverage obtain under the insurance plan of your spouse’s employer.

Once the primary insurer has paid then whatever is left unpaid can be presented to the secondary insurance carrier. The companies are just arguing over which will have to pay the lion’s share of the bill. In no circumstances will they pay more than a combined 100% of the bill. Anything remaining unpaid after both insurers pay what they owe will be up to you to pay.

If you have children covered under both plans then state law will again step in to determine which is primary coverage. One way is designating as primary the insurance plan of whichever parent has a birthdate earlier in the year.

First, sorry for putting this in the wrong forum.

No children.

I’m just worried they’ll come after me for 4 years of over-paying on the part of HCB.

I have never seen overpayment (I don’t even know what that mean - I get a check in the mail?). In fact, it appeared that they always knew about each other prior. Unfortunately, I haven’t kept those statements of benefits so I cannot go back to them. But, I seem to recall some of them acknowledging a portion was paid by the other insurance company.

Does your wife pay extra premiums to cover you through her employer for HealthCoB? If so, does she have an option to not include you for coverage? If so, why are you and your wife paying for dual coverage? Seems wasteful.

Do you include your wife on your employer’s coverage under HealthCoA? Same question as above, if so, seems like you two are doubling up with no real added benefit.

We received those letters every year from BCBS in Illinois. We didn’t have a secondary insurance, so it was a non-issue. I know I’ve gotten them before from prior insurance agencies. We’ve just been changed to All Savers under United Healthcare, and it’s been a mess so far.

Most of us readily assign benefits so the medical provider can get paid directly by the insurer. The insurers are worried about overpaying the provider.

Hypothetical. You are admitted to the hospital and have a procedure that costs $10,000. Assume your deductible has already been met this year. Health Company A (HCA) is your primary insurance from your employer. HCA pays 80% after you met your deductible. Health Company B is your secondary insurance from your spouse’s employer. Suppose it is more generous and HCB pays 90% after your deductible is met.

What should happen is that HCA pays $8000 and then passes the bill to HCB. HCB should realize that they would have been on the hook for $9000 if they were primary, but are happy to get out of there with only paying the remaining $2000. You pay nothing beyond the deductible.

If the primary providers were reversed, then HCB first pays $9000 and then HCA pays $1000.

Not sure how they would hammer it out if HCB has been treated as primary all along. I suspect that it would involved HCB and HCA checking prior bills and then HCB attempting to compel payment from HCA for any over-payment

But if each company did not know about the other, an unscrupulous (or oblivious) provider could bill HCA and HCB separately for the full amount. HCA pays $8000 and tells you to pay the $2000 they did not pay. HCB pays $9000 and tells you to pay $1000 they did not pay. And the provider collects an over-payment, $17,000 in total. Both insurers want to avoid this, but most particularly the secondary payer.

As I said above, her insurance could be classified as Rolls-Royce. She doesn’t pay a thing for herself or myself (and we would not pay extra if we had kids as well). We are not paying for dual coverage.

Do you pay for yourself at your job? If you chose to not elect medical coverage through your employer, would you save money? If so, why not?

ETA: it also doesn’t sound like you are taking advantage of your dual coverage. As you mentioned your employer’s insurance is your primary coverage, and the policy through your spouse’s employer is your secondary coverage. To take advantage, you should be filing medical claims through both, with the secondary coverage picking up some portion that your primary coverage does not. Otherwise why have dual coverage.

Now that first paragraph is a valid point. I pay $30/month for my insurance and I checked and I can waive coverage if I’m enrolled elsewhere. Now the question: Is it better to be double-covered for $360/yr? I go to the dentist a lot (every 3 months) and don’t pay a dime for that. I really need to start keeping those statements I get after going and pay attention to who pays what and what it would cost me to waive my own coverage. I have 9 months before open enrollment when I can make a change.

As to the second paragraph: I know they are charging both because I get the explanation of benefits from both companies after I visit any medical office. And when I recently got glasses, they told me HCA will cover this much and HCB will cover this much so your visit and glasses will be “free”. But, I am not doing any of the filing. The medical offices always bill them. Do some folks pay the doctor and then submit that bill to their insurance on their own?

Sounds like your providers are aware of both coverages and are handling it for you.

You’ll have to do some math to figure out if the B coverage was your primary coverage alone, vs. having dual coverage is giving you more than $360 of benefit a year.

A few people still do this. And in that case the insurers get really nervous.

If HCA and HCB do not know about each other and you are filing direct claims for the full amount with both then combined they might be erroneously reimbursing you more than 100% of the medical costs… essentially going to the doctor becomes a money making proposition for you.

Good thing that’s not what I’m doing. I’m letting my medical providers submit the claims.

It sounds like I didn’t do anything wrong and that it might be the two insurance companies duking it out. I’m not sure how HCB made it 4 years before questioning this.