AboutLinda Woolsteen Expertise I can help you with questions about health insurance. If you feel your insurance company is mistreating you. Are they telling you they are checking eligibity, pre-existing, etc. Or you just don`t understand how your insurance works or don`t understand what a PPO is.. I can help you.
Experience
Past/Present clients One company I worked for I was the underwriter for the Academy of Medicine of Cleveland and the Ohio Bar Association. I was also a supervisor of our customer service department.
Question Hello Linda,
I am covered by UnitedHealthcare federal employees health benefits program as my only primary health plan. My wife, who has been on LTD since 1991 due to Multiple Sclerosis, had a disability health plan with Medicare as primary. After my wife and I married in 2004, she was added to my health plan as a dependant in 2005. The dilemma that has surfaced is during an episode that required her to go to a hospital emergency room in 2008, the hospital sent the claim to the disability health plan instead of the primary (UHC) and UnitedHealthcare has stated in order for UHC to pay for the treatment, the disability health plan should be closed.
Without getting bogged down in to much detail, it is understood that the working party's plan is considered primary, Medicare as secondary and the disability health plan classified as third or possibly supplemental, therefore, is it really necessary to close her disability health plan before UHC assumes its role as primary and in doing so would it affect her eligibility coverage with Medicare Part B? Thank you for any insight into solving this dilemma.
Answer Hi,
I sincerely apologize for not replying sooner. I was not able to log into the site for some reason. I have never had this problem as you may note from how fast I have responded to questions in the past.
I am not sure if I can really help on this one. When I worked for the Insurance Company that I worked for... I never saw an occasion where we told anyone that they would need to cancel one of their other plans.
I know that a lot of people (including employees of Insurance Companies) have a hard time with COB (Coordination of Benefits) since it can be very confusing at times. I also would have to say that I honestly couldn't make heads or tails out of how our claims department would come up with the figures that they paid out when they were coordinating benefits and I do not honestly think they were so sure of themselves either.
The only reason I can see that you may have been told that, is simply because an employee was making the statement by meaning that it would be easier and less confusing for all involved.
Or, other than that, that maybe they are thinking your wife is not really eligible for the Disability Health Plan any longer since she is covered under a traditional health plan now as well. Usually, anything like a Disability plan is just as you said, just considered as a supplemental type plan.
If UHC is having problems paying because they are unsure of how to coordinate with the other plans, the paper claim can always be submitted to the other plans in order to receive an EOB (Explanation of Benefit Form) that will simply state they denied the claim. Once they have the EOB advising how the other carriers handled the claim, they should be able to continue with processing.
You may want to run the question by your State Department of Insurance and see what they say.
