Insurance question - is having double coverage screwing me over?
December 9, 2017 8:14 PM   Subscribe

Short version? Kaiser Permanente is refusing to cover anything because my Other Insurance (this year it's Blue Cross) says KP doctors are out of network. My out of network deductible is $5k and I now have this huge bill from what I thought were covered doctor visits at KP. And if I have to just eat it this year, fine. But I like having double coverage, and now I have an Idea. Will it work? Long version inside.

I've had double coverage (health benefits through my job - always something like Regence, Blue Cross, etc. plus Group Health-now Kaiser Permanente- through my wife's job) for, oh, 17ish years now and it's always worked great. Until now. And now it's time to make Insurance Decisions for next year, and I need some help.

I had to have some medical procedures this year that having double coverage has really helped - trauma therapy, endoscopy, colonoscopy, and a capsule endoscopy. These have been covered very well because KP referred out. But the routine visits? KP says they won't cover any of those because they "always go along with what the primary insurance says" (and they say KP is out of network). I am in the process of disputing this, but tonight at the gym I got an Idea.

Would it be ethical/possible to keep both insurances but going forward, tell KP that I only have their insurance? I'm guessing this would work fine for routine care, but then if I have to get any more Fancy Procedures, could I pull out my other coverage and not have that get back to the medical center where I get routine care?

FWIW, I think the problem happened when someone at KP asked me which was my primary insurance. They had always had my wife's insurance down as my primary, so when that switched, the billing issues began. I like having double coverage because it's inexpensive and I have some health anxiety, and also because I finally found a doctor who I like - and they are out of network for next year's insurance (Aetna) through my job.

I know this is very #firstworldproblems but any experience/information you have would be much appreciated.
posted by fleecy socks to Health & Fitness (6 answers total)
You were committing fraud when you told anyone that your wife’s insurance was primary. Your coverage is always primary and secondary insurance only pays what primary won’t. You would be committing fraud to “neglect” to tell providers about your primary insurance.
posted by Automocar at 8:43 PM on December 9, 2017 [1 favorite]

So every other issue side, the insurance companies somehow talk to each other - I got a bunch of stuff declined from Blue Cross because United somehow told them they were covering me (they weren't but this system of theirs thought they were, many many phone calls ensured). I certainly never shared that with them. I don't know by what mechanism they knew, but they did.
posted by brainmouse at 8:59 PM on December 9, 2017

Response by poster: Thanks for the reality check, guys. I don't want to do any frauding. (I didn't say her insurance was primary - my hunch is that they had it down like that until I corrected it)
posted by fleecy socks at 11:01 PM on December 9, 2017

Withholding information from your insurers that could conceivably be relevant to their business relationship with you is a pretty sure-fire recipe for letting them completely weasel out of anything resembling a payout when (not if) they find out that that's what you've done.

And they generally won't tell you that they've found out that that's what you've done; they'll happily keep on taking your premiums until you give them the opportunity to weasel out of a claim by making one. Which is generally the worst possible time to find out that kind of thing.

Even if you're being less than up-front with an insurer to an extent that doesn't actually count as fraud, you're opening yourself up to a fairly high risk that the fine print in your policy will give you no recourse after they deny your claim.
posted by flabdablet at 3:24 AM on December 10, 2017

they'll happily keep on taking your premiums until you give them the opportunity to weasel out of a claim by making one.

Oh, so true. Even if you're completely ineligible for coverage, they will take your premiums for years. When the error is discovered when you make a claim, they'll at best refund the premiums you've paid.
posted by GhostintheMachine at 6:10 AM on December 10, 2017 [1 favorite]

In addition to the points above, it is important for all your doctors to be on the same page. The medical system is rife with errors - and not just billing errors. My 83 year-old coworker was prescribed the wrong antibiotic for a persistent UTI, which delayed his recovery by at least a week. Your primary care may see something that your specialist doesn't, and vice versa.
posted by invisible ink at 1:53 PM on December 10, 2017

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