Can I have two health insurance policies?

January 3, 2006 2:35 PM

I currently have an excellent health insurance plan - however, it does not cover a medication my doctor would like to prescribe. It is available on my spouse's plan, however. I don't want to change insurers because my doctor only accepts my exisiting company, and I want to keep her. However, I can get onto my spouse's policy for quite a bit less than the monthly cost of the medication. Is this legal? Ethical? Are there any pitfalls? Would one insurance company be able to share information about my medical history with another? Would there be trouble for me if I became seriously ill? Thanks!
posted by soulbarn to health & fitness (12 comments total)

because of HIPPA your insurance companies definitely can't share information without a waver from you. HIPPA is almost insane. In fact, your hospital can't even share information with your insurance company without a waver from you.
posted by delmoi at 2:50 PM on January 3, 2006

I am not an insurance lawyer (or whatever) just someone with my own insurance and my wife's insurance. I don't see why this would be a problem at all, lots of people are double-insured and it's a benefit. You aren't only supposed to have insurance through a spouse if you don't have your own.

I don't know whether they share info, even if they did I don't see why it would be a problem. I can get lots of things through my wife's plan that I can't get through mine. It's the same company even, so they know about it and it's not a problem for us.

The problem I can forsee is with the doctors. If your doctor only accepts your existing ins, and you don't want to change, wouldn't that involve having two doctors? Aren't there usually problems with that?
posted by crabintheocean at 2:51 PM on January 3, 2006

I think this is just double coverage. My wife and I had it for a time, and it was not a problem (of course this was several years ago, so things may have changed).

Basically, the insurance companies had a methodology for determining which company had primary responsibility (I think it was the company of the person with the earliest birthdate), and all claims went to that company first, then the remainder of the claim was settled by the other company. Far from being a trouble, the arrangement provided extra coverage. For instance, my wife's plan only covered 1 day post partum, and mine covered 2, so when she had our last child, she stayed 2 days, and the hospital dealt with the paperwork issue of submitting which claim to which company.

I would just call the companies involved and ask them. As far as sharing info, I'm sure that goes on, subject to all the HIPAA privacy issues and consent issues.
posted by jasper411 at 2:51 PM on January 3, 2006

Also, I have heard rumors of people in your kind of situation getting a doctor to just prescribe the medication for the spouse (assuming you have the same doctor, and it's not a condition where that would seem odd on their records). I don't think you need to do that though, your situation sounds good to me.
posted by crabintheocean at 2:53 PM on January 3, 2006

(To clarify - I didn't mean that people have the spouse fake the symptoms - just that the doctor puts the prescription in the spouse's name)
posted by crabintheocean at 2:55 PM on January 3, 2006

I worked for a software company that wrote healthcare billing software and it's quite normal to have multiple insurance companies, usually the way it works is the primary insurer is billed for the full amount, and anything they don't pay is then sent off the 2nd insurer, and so on down the line until there are no insurers left, and then patient gets to pay the remainder.
posted by blue_beetle at 3:10 PM on January 3, 2006

I don't know about the legality, but ethically: You're paying for both insurance policies, you should be able to get the benefits of both.

"I'm paying?" you ask? Yes. You're paying. It's a part of your salary, and it reduces the take home pay you get. Whether or not you actually pay a percentage of it (you probably do), you or your spouce would be taking home more money if you did not have that insurance policy. You're paying for it in your dollars, or at the very very least, in your labor.

I see no reason why you should feel it is unethical.
posted by twiggy at 3:14 PM on January 3, 2006

You can definitely be enrolled in two health plans at the same time. People do it all the time, and it's not unethical (it is, however, one of the the major reasons why employers almost never offer medical insurance with no employee contribution at all). The fact that a drug is not on one insurer's formulary won't have any impact on how it's covered under another insurer. I posted about how it works here, and I'm too lazy to repurpose the answer.
posted by MarkAnd at 3:22 PM on January 3, 2006

Legal, ethical, & recommended.
posted by caddis at 6:34 PM on January 3, 2006

It's very common. Everything will go through "your" insurance (which will be called your primary insurance) first, then whatever isn't covered, including your copay, deductible, etc. will go through your wife's insurance (which will be called your secondary insurance).* If you became seriously ill, this would probably save you a lot of money.

*This is how the dividing is done in New York, though it may vary by state. In any case, having two kinds of health insurance is not uncommon and will be routine for your health care providers' billing department.
posted by leapingsheep at 10:48 PM on January 3, 2006

Double coverage is usually fine. If there's a serious medical issue, the insurance companies will fight it out over who has to pay...but better that than the alternative, not being able to get treatment.
posted by dejah420 at 7:51 AM on January 5, 2006

Have you tried to get your insurance company to allow for the prescription? If it's "medically necessary," you may get a break. Your insurer will have an appeals process you'll have to go through.
I have acid reflux and had wonderful luck with one drug. Then my new insurance company would not pay for it. I tried two other drugs before my doctor appealed for me to my pharmacy benefit to get the old drug. (The other two plain did not work for some reason.)
posted by FergieBelle at 3:54 PM on January 6, 2006