Does anyone have experience with having double health insurance?
August 3, 2023 5:04 AM Subscribe
Does anyone have experience with having double health insurance? We've ended up with coverage overlapping for a month w/Kaiser and a PPO plan. I am mostly going to be wrapping up appointments at Kaiser and transferring care to the new plan. Do I have to tell them about the other insurance? I'm not sure how it would affect things given how Kaiser works. Will it end up costing me more? I'm looking at a handful of appointments and maybe 1-2 lab tests.
This is how it works with my dental insurance, and I assume it would be similar but not exactly the same for health:
One is your primary insurance and will need to be billed first. If this is a situation where two different people are covering the family through their employer plan, the person who works at the job providing the Kaiser plan has Kaiser as their primary and the PPO as their secondary. The person working the PPO providing job has that as their primary insurance and Kaiser as their secondary. I am not sure how it works for other family members. I'd tell them about both insurances and be clear which is primary for the patient if you know. We have had a lot of things covered by secondary insurance that were not by the primary and it has saved a lot of money.
posted by soelo at 6:23 AM on August 3, 2023 [1 favorite]
One is your primary insurance and will need to be billed first. If this is a situation where two different people are covering the family through their employer plan, the person who works at the job providing the Kaiser plan has Kaiser as their primary and the PPO as their secondary. The person working the PPO providing job has that as their primary insurance and Kaiser as their secondary. I am not sure how it works for other family members. I'd tell them about both insurances and be clear which is primary for the patient if you know. We have had a lot of things covered by secondary insurance that were not by the primary and it has saved a lot of money.
posted by soelo at 6:23 AM on August 3, 2023 [1 favorite]
For other members of the family my experience has been that “the birthday rule” applies — the person whose birthday is earlier in the year is the one whose coverage is billed first.
The secondary does need to know about the primary, and what it pays out will sometimes be affected by what the primary has paid (i.e. it will make sure that the two combined don’t pay the provider more than the cost of the procedure…)
For what it’s worth this can be a really good situation to stay in if the premiums are manageable and the two coverages are complementary (an HMO with good local coverage and routine care, and a PPO to make sure out of the ordinary care, care far from home, and providers not associated with the HMO, etc are well covered too). Given that one will sometimes pay what falls into the deductible for the other the net might even be a cost savings, but even if it’s not the belt-and-suspenders coverage can be very reassuring nowadays.
posted by sesquipedalia at 7:50 AM on August 3, 2023
The secondary does need to know about the primary, and what it pays out will sometimes be affected by what the primary has paid (i.e. it will make sure that the two combined don’t pay the provider more than the cost of the procedure…)
For what it’s worth this can be a really good situation to stay in if the premiums are manageable and the two coverages are complementary (an HMO with good local coverage and routine care, and a PPO to make sure out of the ordinary care, care far from home, and providers not associated with the HMO, etc are well covered too). Given that one will sometimes pay what falls into the deductible for the other the net might even be a cost savings, but even if it’s not the belt-and-suspenders coverage can be very reassuring nowadays.
posted by sesquipedalia at 7:50 AM on August 3, 2023
When I was on disability (and I was unemployed at the time), I got access to Medicare. I've now been employed, but I keep two health insurances, Medicare and my employer-sponsored one.
It took a while to figure out, but when I was at a small employer. I would tell providers that Medicare was my primary insurance and the employer-provided one was my secondary. Now I'm at a large employer ("large" meaning more than a threshold number of employees), and the primary-secondary insurers are reversed.
I keep both insurers because I need to go to doctors a lot and sometimes need expensive treatments. It keeps my out-of-pocket expenses low.
Health insurance is super-confusing, and in your situation, I don't know which one is primary and which one is secondary, but I would think it would be beneficial to give providers both insurers during any months you have their coverages. It could reduce your out-of-pocket expenses to nothing.
posted by Leontine at 8:02 AM on August 3, 2023
It took a while to figure out, but when I was at a small employer. I would tell providers that Medicare was my primary insurance and the employer-provided one was my secondary. Now I'm at a large employer ("large" meaning more than a threshold number of employees), and the primary-secondary insurers are reversed.
I keep both insurers because I need to go to doctors a lot and sometimes need expensive treatments. It keeps my out-of-pocket expenses low.
Health insurance is super-confusing, and in your situation, I don't know which one is primary and which one is secondary, but I would think it would be beneficial to give providers both insurers during any months you have their coverages. It could reduce your out-of-pocket expenses to nothing.
posted by Leontine at 8:02 AM on August 3, 2023
You should look up your state and google "Primary/secondary co-insurance " and find the rule. Because your insurance you think will pay may differ state to state.
posted by sandmanwv at 8:15 AM on August 3, 2023
posted by sandmanwv at 8:15 AM on August 3, 2023
you will want to contact both insurance companies and do a coordination of benefits (COB) and then do it again when the Kaiser plan terminates. The insurance companies have rules about which one is primary - do not try to guess, let them figure it out. Failure to do so can create huge headaches later if the secondary got billed first and paid and then they later (months and months later) take back the payment because they were really secondary and meanwhile it is too late for the provider to bill the primary.
It should not cost you any more.
If you go see someone at Kaiser and If Kaiser is primary, they will just charge you the normal amount. You can then file a secondary claim with the new insurance and depending on your out of network coverage, (do you have any, how big is the deductible) they may pay you something to cover your out of pocket costs. If the new plan is primary, they pay according to the out of network rules and then you file the secondary claim with Kaiser and they will pay normally.
If you see someone outside of Kaiser, Kaiser won't pay and the new insurance pays according to their own rule. So, if Kaiser is primary, the medical provider has to file a claim, get it rejected and then file a secondary claim. If new insurance is primary, the claim is filed with them and you don't both with a secondary because Kaiser won't pay anyway. So maybe more paperwork but should be less or the same actual cost.
posted by metahawk at 11:12 AM on August 3, 2023 [2 favorites]
It should not cost you any more.
If you go see someone at Kaiser and If Kaiser is primary, they will just charge you the normal amount. You can then file a secondary claim with the new insurance and depending on your out of network coverage, (do you have any, how big is the deductible) they may pay you something to cover your out of pocket costs. If the new plan is primary, they pay according to the out of network rules and then you file the secondary claim with Kaiser and they will pay normally.
If you see someone outside of Kaiser, Kaiser won't pay and the new insurance pays according to their own rule. So, if Kaiser is primary, the medical provider has to file a claim, get it rejected and then file a secondary claim. If new insurance is primary, the claim is filed with them and you don't both with a secondary because Kaiser won't pay anyway. So maybe more paperwork but should be less or the same actual cost.
posted by metahawk at 11:12 AM on August 3, 2023 [2 favorites]
« Older AUS language: Yeh Yeh Verse Yeaah Yeahh | The right shovel for digging up a few inches of... Newer »
This thread is closed to new comments.
posted by AlexiaSky at 6:13 AM on August 3, 2023