Health Insurance C.O.B. and the "birthday rule" for divorced parents

I, my son, and my ex-husband live in Massachusetts. We’ve been divorced almost 2 years. My ex and I both are employed and both cover our son under our employer’s health insurance. Our son lives with me, and I have financial responsibility for him. The reason my ex has insurance for him is in case I am ever laid off, my son will still have uninterrupted coverage (the ex works for the government).

When we were married, the “birthday rule” meant that my husband’s insurance was the primary coverage for our son. Now that we are divorced and our son is in my care, I consider my insurance to be primary. They usually pay claims as the primary carrier. Ocassionally I get a statement from them saying that the other is primary, but I call them or my employer and get it straighted out. The insurer’s rep was supposed to have put a note in my file to the effect that my insurance is primary.

So I just got another bounce-back statement. I phoned the insurer and got some flunkey on the phone who insists that the “birthday rule” applies whether or not there is a divorce, etc.

IF this is true, then it would be a big pain in the butt for me to handle my son’s medical bills, because anything going through my ex would be sent to his address, he is a relatively delinquent person, etc.

So what’s the truth about this “birthday rule” when parents are divorced?

I just started a job dealing with filing insurance claims for a hospital. IANAIE (insurance expert, yet :D), but IIRC, the rule stands no matter what the marital status. When you have to file a claim, be sure to present your husband’s info as primary and yours as secondary. The healthcare facility should file them in the correct order. You shouldn’t see a statement of any kind until all insurances have paid (or denied, as the case may be) and you (and/or your husband) are required to pay a deductible or co-pay (if any).

Since I first posted, I did some web surfing, and it looks like since I have financial custody, that my insurance company is supposed to be primary? Is there a law about who is primary? Or does each company just decide on their own?

Former insurance employee checking in, but it has been a while so I may not have every last detail correct and things change from company to company. The first thing I’d suggest you do is read your policy. This will explain the birthday rule and other aspects of COB. The marital status of the policy holder makes no difference as to whose benefits are primary if the company uses the birthday rule. There is no specific law which mandates the use of any particular rule for COB between two private insurance companies. Wen you’re talking Medicare, there are boatloads of rules as to which is primary. “Financial custody” is irrelevant to COB unless your divorce decree specifically states that one parent or the other is primarily responsible for insurance coverage. Even then insurance companies will not necessarily assume that the decree means that one plan or the other is primary. The birthday rule replaces the previously widely used and discriminatory gender rule which mandated that the male’s insurance would be considered primary.

I do not suggest that your ex drop your child from his insurance policy, but if it’s going to be a huge hassle for you to deal with COB issues either you or your ex can drop your son. Should the other partner lose insurance coverage, your son would be considered to have had a 'qualifying event" which would allow him to be added to the other’s plan without any type of waiting period or pre-existing exclusions provided the previous coverage was sufficient in duration to satisfy the other plan’s waiting periods.

I don’t know why your ex would need to be involved in insurance claims for your son. The provider should be filing claims with the primary insurer then filing the claim plus the explanation of benefits with the secondary. There’s nothing your ex should need to do to facilitate that process (provided of course there’s no issue like subrogation which requires his response to paperwork).