Life & Health Insurance/Double Insured: Am I Going to Pay Big Time Because of This?
QUESTION: Hello Mr. Higgins,
I would like to ask a question regarding how the billing works according to Coordination of Benefit rule and how you’re going to be billed as a result compared to just having a single insurance.
I have two health insurances, and COB processing is pending right now regarding my recent medical bill. The decision has not been made yet, but I have been told by someone in the billing department of a care provider that, because one insurance is older than the other, I will be forced to use the bad insurance first and then use the other one( a good insurance, finally) for the rest. I have the both insurance as a subscriber: the bad one is the one I enrolled with my daughter as per Obamacare (without being subsidized), and the newer one provided for only me by my employer.
Do I have to pay the deductible of the primary insurance after they are done processing the bill before the secondary gets billed? The first one does not have co-insurance.
This is very important to me, because the one I’ll be forced to use as the primary insurance, is a very bad insurance with a massive deductible ($12,700/family, and my bill is big enough--$13,000 and up-- that this matters) as compared to the secondary one with great coverage benefits(it’s my employee/union provided), and if I have to pay the deductible as per the policy of the primary insurance, this could be a huge blow to my financial situation.
Would you please be able to help me understand how this works…?
I have e-mailed the insurances’ customer services, but no answer is given yet.
I would love to know how the billing system (deductible and all) in this case works from someone who knows about the system. I have a problem making out what someone on the other side of the phone is saying, so I usually go on-line such as e-mail in order to communicate with customer service of many kinds.
I thank you very much for your offering your expertise, and working hard in doing so.
Please have a great week.
ANSWER: Hello, Yuka:
You will likely not have to pay any of the medical bills or deductibles.
Here is an excellent article that explains Coordination Of Benefits much better than I ever could, http://hcvadvocate.org/hepatitis/hepC/Duplicate_HI.html
However the two insurance companies involved in your current medical bills handle these claims, the bottom line is that you are to be made, "whole," that is, be in the same financial condition as before the medical condition occurred. The purpose of COB is to make sure all of your medical expenses/deductibles are covered by the insurance companies, but that you don't profit from the medical procedure by collecting full benefits from both insurers.
After reading the article, please let me know if you have further questions.
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QUESTION: Hello, Mike:
Thank you so much for your quick response. Your guidance has been very helpful! You are great, Mike.
I went to the suggested site, and the table (COB Endorsement) which is found at the bottom of the article’s PDF version* says that both plans pay full benefits when the dual coverage between an individual plan and a group plan (by employee) is concerned. I don’t understand this. This is quite confusing since the both parties involved (primary and secondary) seem to eventually have to pay their full benefits anyway in all the other circumstances . Would you be able to give me a ‘dummy’ version of what this means?
I thank you again for your brilliant expertise. This is quite intriguing.
Please have a wonderful day.
The article states...
"It is important that you review the provisions of an individual health insurance policy because they will sometimes include their own provisions about other insurance."
Not knowing what your individual contract includes regarding COB, (or how the individual plan addresses, "Other Insurance," it is impossible to give a definitive answer. Whether you can collect more than the actual claim amount because you have both an individual and group plan is something that will have to be determined elsewhere. As far as your original question and concern about the possibility of you having to pay a high deductible before the claim is paid, I do not believe you will have to, thanks to COB.