Dual medical insurance question

[Really_Not_All_That_Bright]

@wguy123

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.

Start looking at the Explanation of Benefits forms you get after each medical visit and see how much each insurer is paying, and what your copays/coinsurance would be otherwise. If you go to the doctor a lot you might well be saving money at $360 per year.

[wguy123]

@Really_Not_All_That_Bright

Start looking at the Explanation of Benefits forms you get after each medical visit and see how much each insurer is paying, and what your copays/coinsurance would be otherwise. If you go to the doctor a lot you might well be saving money at $360 per year.

It’s really the dentist I use. Peridontal disease requires 4 cleanings a year and I seem to break at least one tooth every couple years. I hope that when I die, someone gets to cash in all the gold I have in there.

Thanks for the advice all. Sending the form and hoping for the best. Definitely going to start paying attention to who’s paying what.

[Mama_Zappa]

@Really_Not_All_That_Bright

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.

Sort of. If insurer B had been paying claims as if they were primary, they might have a legitimate claim - as in, you could have been getting over-reimbursed.

We carried dual coverage for a number of years. The way it used to work was if, say, A paid 80% of the 100 dollar charge, then you’d file with B. B would look at the charge, figure they’d pay up to 80%, see that A had already paid 80 dollars, so they’d pay their 80% up to the actual cost. So for a 100 dollar fee, they’d pay the 20 dollars. When secondary coverage was very cheap for us, it was just about worth it.

Then the companies began changing. They’d decide “we’ll only pay up to whatever we’d have paid”. As in, if A paid 80 dollars, and B would have paid 80 dollars, B says “Oh, you’ve already gotten your 80 dollars, we ain’t payin nothin’, thanks for the free premiums, sucka!”.

As in, we were paying the premiums, and getting nothing in exchange.

We do still carry dual coverage for each other’s dental insurance - my husband and I are at an age where we often have high enough dental bills that it can be worth it. Anything major, and we’ll hit the fairly small coverage limit of 2,000 dollars - after which the secondary might cover something.

[GrumpyBunny]

@wguy123

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:

Our records indicate Wguy123 may have/had other insurance coverage. Please complete the enclosed form and return it along with a copy of any applicable insurance ID cards. Upon return of the form, any claims that have been paid incorrectly will be adjusted accordingly.

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

Eh, don’t get upset. They are trying to bump it back to HealthCoA as primary. Send HealthCoB the required information and an EOB from HealthCoA (if you have one and if requested), and let the insurance companies handle it. You could even call HealthCoB to explain what’s up, but give it about ten business days for your correspondence to get into the system so the CSR can see it.

It benefits you to have both cards on file with your physicians. You don’t have to tell the insurance companies that you have coverage elsewhere. That information comes to HealthCoA and HealthCoB in the bills the provider sends to the insurance companies. There are billing guidelines in place for the exact scenario you describe. You didn’t do anything wrong.

[GrumpyBunny]

@Iggy

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.

All of the OP’s providers know about the situation and have both cards. If the physicians are billing the claims correctly, there is no reason this would occur. Secondary coverage is not uncommon, so part of the standardized billing guidelines cover just this kind of situation.

[wguy123]

@GrumpyBunny

Eh, don’t get upset. They are trying to bump it back to HealthCoA as primary. Send HealthCoB the required information and an EOB from HealthCoA (if you have one and if requested), and let the insurance companies handle it. You could even call HealthCoB to explain what’s up, but give it about ten business days for your correspondence to get into the system so the CSR can see it.

It benefits you to have both cards on file with your physicians. You don’t have to tell the insurance companies that you have coverage elsewhere. That information comes to HealthCoA and HealthCoB in the bills the provider sends to the insurance companies. There are billing guidelines in place for the exact scenario you describe. You didn’t do anything wrong.

Thanks for the reassurance. I’ve sent the paperwork. If I get anything back or anything comes from this, I’ll update this.