With Primary and Secondary Insurance your primary denied your claim because it was over a year is your secondary obligated to pay?
Yes, subject to the limits in their policy. Answer No. With most insurance policies, there is what is called a timely filing limitation. For my company; contracted providers have 6 months, and non-contracted providers have 12 months to submit the claim. If your primary insurance received the claim within timely filing, you may have the option of submitting the claim to your secondary with proof that it was filed in a timely manner. If that doesn't work you can always appeal the decision with the secondary or for that matter the primary insurance company. Policy holders are not responsible for claims that deny for timely filing.
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That would be covered under the terms of your policy. In general that is what supplemental, (secondary) insurance is primarily for. Most "supplemental" plans pay the 20% that Medicare didn't pay only AFTER seeing an "explanation of benefits" statement--i.e. proof that Medicare paid their part. If M…edicare denies a service all together, the supplemental plan is often under no obligation to pay at all, as they are there to "supplement" Medicare, not take the place of it in cases of denial. This is especailly true if Medicare denies because the service was deemed "not medically necessary". So, in short, no. Medicare supplements often do not cover services if they are denied by the primary (Medicare). (MORE)
Will secondary insurance pay the co-insurance amount of primary insurance if you have met the deductible in secondary insurance?
Answer . You're going to have to look at your policy or brochure to see what the provisions are.\n. \nFor more details see www.steveshorr.com/supplemental.htm.
If you have a copay with your primary insurance but also have secondary insurance do you have to pay the copay before treatment?
%DETAILS% Depends on the doctors office billing procedures. For more details visit www.SteveShorr.com yes, your secondary insurance should cover this amount if you have reached your deductible with them. Normally, if the primary insurance applies a deductible or co-insurance/co-pay and you have not… met your deductible on your secondary policy, depending on your policy they may apply the remaining balance to your deductible. Normally after the deductible is met on the secondary ins. they pay 100% of your remaining balance. (MORE)
Can Secondary Insurance not pay anything on claim if Medicare pays more on claim than they would if they were primary?
Yes, If medicare pays more than the secondary insurance allows for a charge, the secondary insurance pays nothing. The balance is written off to a contractual allowance that is agreed upon between the provider of service and the insurance company via contract.
Are health care providers obligated to accept payment from a secondary insurance at their fee schedule when the provider does not participate with the the patient's primary insurance?
Answer . \nIt has been my experience that providers of health care are not obligated to accept secondary or even primary insurnace coverages if they are not under contract with that insurance company. I believe they are free to accept no insurance coverage at all and demand "cash" up front if th…ey so desire. This would leave it your responsibility to sent the bill to your insurance(s) carrier(s) and get direct payment assuming they cover out of panel care. Some providers can not refuse you care even if you had no insurance but you would be responsible for the cost of care. (MORE)
Answer . \nAs long as it is a covered expense by your secondary insurance and a claim has been filed with the primarty insurance then the answer is yes. The secondary insurance will only cover the expense according to your plan.
Answer . \nYes, if the secondary insurance plan covers it In the pharmacy (drugs) world of primary and secondary coverage, this is true.
You need information on how copays effect primary and secondary insurance If you pay your copay on primary does that off set your copay on secondary and would secondary pay remaining portion of bill?
Answer . I don't quite understand your question. Check this link http://www.steveshorr.com/technical_questions.htm#Primary for links to explanations of dual coverage. Have you read the applicable provisions in your policies?
Depending on your coverage, your primary insurance will cover 80% of your charges, minus your deductible (if not already met). Your secondary insurance will pick up the remaining 20% co-insurance and your co-pay, if you have one.
The secondary insurance cover both pays and co-pays of the primaryinsurance depending with the insurance company.
If you are on two medical insurance plans and the primary will not pay for a prescription can the secondary be used to cover it?
Answer . Depends what the 2nd policy pays for. Doesn't hurt to send in the claim forms. Try reading the policy or brochure.
You have two primary health insurances and want to know if they both have to pay as primaries not as a secondary and what happens if a bill gets overpaid when they both pay?
Answer Eventually the insurances will figure out that one is overpaying and they'll get refunds from the doctors. Note that some policies do not coordinate and then they both might pay as prime correctly.
Secondary medical insurance is a second level of insurance coverage. Under most circumstances, the two policies are independent of each other. One policy may pay for a service while the other may not. The primary policy must pay first, then the secondary. The choice of which policy is primary or sec…ondary is established by a shared rule between insurance companies. It is not the policy holder's choice. Examples of Primary/Secondary coverage: A husband and wife both work and carry the medical insurance offered by their respective employers. The husband adds his wife to his policy. The wife adds her husband to her policy. Under most circumstances, the husband's plan would be his primary policy and his wife's plan would be his secondary policy. In like manner, the wife's plan would be her primary policy and her husband's plan would be her secondary policy. (MORE)
Can the secondary insurance provider deny a claim that was not filed with the primary insurance provider first?
\n. \n Answer \n. \nLet me tell you what happend to me. I hope that this helps. I used to be covered by two insurance companies. My primary insurance company was through the company that I worked with. My secondary was with the company that my husband works with. When a claim was filed with… my secondary insurance company they wanted to know how much my primary insurance company paid for and until then they would not pay anything. So I had to submit to my primary insurance company and once they paid some then the secondary would. I hope that this helped:)\n. \n . \n Yes.\n. \nA claim must always be made with the primary insurer first. (MORE)
Are health care providers obligated to accept payment from a secondary insurance with whom they participate when the provider does not participate with the patient's primary insurance?
Yes they will have to accept payment from the secondary insurance, however they will have to bill the primary provider first.. What ever the primary insurance does not cover should be covered by the secondary insurance.. However, it will depend on the service being provided and the contracted amou…nt that each insurance has agreed to pay.. If the primary pays more than the secondary would have paid -there may be a refund due.. However, there may be co-pays and deductibles to be met with both insurance policies.. There could also be write downs--- you should only pay the lesser amount. the provider may have to take a loss if one insurance has a lower contracted amount (MORE)
Will a secondary insurance pay a portion or all of a prescription that a primary insurance will only pay part of because they will only pay for a lower dosage?
In most cases a secondary insurance would compensate coverage werethe primary insurance does not. Exceptions apply to theprescription drug type and coverage limitations.
The subscriber whose birthday comes first in the year is primary. The year is not considered. So a subscriber with a January 1 birthday is primary over the subscriber with a January 2 birthday. Hope this helps.
Not necessarily; a secondary insurance policy or plan might only provide additional benefits up to the maximum that it will pay for a specified service. If both plans have rates that are similar, this might result in a small additional payment. Some secondary insurance or health plans might pay up t…o their maximum -- in addition to what the primary pays, which would result in a higher payment against a claim. (MORE)
You have Medicare as primary insurance and BCBS as secondary insurance Do you pay the copay on the secondary insurance?
The answer to this question depends on what kind of secondaryinsurance you have - is it a group health plan? Is it asupplement? . If Medicare is primary, there are still deductibles, copays,coinsurance that would need to be satisfied by your secondaryinsurance. . Based on your question, I'm assumi…ng that you have a group healthplan with a copayment as your secondary insurance. If so, then yes,you would pay your copayment but it would not exceed the part Bdeductible. (MORE)
You could have two insurance companies pay the same medical bill or claim for a date of service through a process of subrogation where the first insurance company determined by the effective date of coverage will pay their portion of the bill and the second insurance company will pay the balance. Th…is process is called coordination of benefits. Secondary medical insurance is a second level of insurance coverage. Under most circumstances, the two policies are independent of each other. One policy may pay for a service while the other may not. The primary policy must pay first, then the secondary. The choice of which policy is primary or secondary is established by a shared rule between insurance companies. It is not the policy holder's choice. Examples of Primary/Secondary coverage: A husband and wife both work and carry the medical insurance offered by their respective employers. The husband adds his wife to his policy. The wife adds her husband to her policy. Under most circumstances, the husband's plan would be his primary policy and his wife's plan would be his secondary policy. In like manner, the wife's plan would be her primary policy and her husband's plan would be her secondary policy. Secondary insurance should not be confused with supplemental insurance. Supplemental policies usually abide by the primary insurance guidelines. If the primary allows the charge, the supplemental will allow the charge. Most supplemental policies cover the charges you would normally pay out of pocket. For example: A Medicare supplemental policy would cover the 20% coinsurance left over after Medicare pays 80% of the allowed amount. (MORE)
There is one major difference between these types of claims. When aperson has two different insurance carriers, one of them isdesignated as the primary coverage and the other as the secondary.The primary insurance should be billed first and normally pays thebulk of the bill. The secondary insurance …gets billed for theremainder of the bill which the primary insurance did not pay for. (MORE)
Can you change your secondary insurance to primary insurance if your coverage is better with the secondary insurance?
In most cases no. You can not chage due to better coverage. 90% of insurance companies, if not more, have what is called a birthday rule. Meaning if you have dependant children on the policy the guardian who was born first (or who is older) is the primary carrier for the dependant children and the y…ounger of the two guardians is the secondary carrier. If you were to have coverage through yourself and a spouse you would be your own primary, as would your spouse be their own primary. If you are the carrier for both insurances then it would all depend on your plan provisions and restrictions, in which case you would have to question each insurance company as to how they would handle determining what insurance is primary and what insurance is secondary. (MORE)
The primary coverage is provided under the plan provided by theemployer. Secondary coverage is usually a result of being coveredas a dependent under someone else's health insurance plan.
You have had payments for claims recouped because the insurance company was secondary the primary insurance company is denying the claims recouped due to timely filing Is there anything you can do?
If your health insurance is thru your employer, have them contact their account rep. These issuse can be magicaly resolved when it is time to renew the company policy, if the rep is informed thast the company will seek another provider should it not be taken care of.
A primary source is a document, speech, or other sort of evidence written, created or otherwise produced during the time under study. Secondary sources provide interpretation and analysis of primary sources.
When you have a primary and secondary insurance will the co-pay from your primary insurance be paid by the secondary insurance?
I have insurance paid for by my employer (primary) and through my husband's employer (secondary). In my experience, I have never had to pay the copay required by my primary because it is covered by my secondary. When I first got married, 2 years ago, I still paid the copay, but the doctor's office w…ould always send me a check for the copay a month later because the secondary paid it. (MORE)
If both policies are with the same company, and if you or your employer pays the premiums on them, then yes, they both pay. That is actually common; quite often the husband's insurance through his employer is through the same insurance company the wife's job has.
If a husband and wife both have dental insurance through their employers, the employee's insurance is primary when the employee is the patient, and it must pay it's benefits. The spouse's insurance is secondary, and will only pay once the primary insurance has paid. Depending on how the policy is wr…itten, sometimes the secondary insurance will pay any residual fees up to the annual maximum. Sometimes the secondary insurance only pays if their fee schedule allows higher fees than the primary insurance. This assumes that each spouse is named as a dependent on each other's policy. Ask the insurance coordinator at your dental office to what benefits are available between the two policies. (MORE)
When a primary insurance payer pays 0 on a 1000 bill and a secondary pays 700 with a 700 contracted amount do you have to pay the difference 300?
With out a doubt...yes. Unless your dentist is a contracted provider through your insurance company, in that case they might have to adjust your account to what the contracted (allowed) fee is per the insurance company. If they are not a contracted provider they don't have to adjust one dime!
Primary insurance coverage is what is first used when a medicalservice is being rendered. This is what will be billed first.Secondary insurance is supposed to cover what the primary insurancedoes not.
If the primary insurance allows more than the secondary insurance what would the secondary insurance pay?
Secondary insurance will not pay the claim but the remaining charges should not be billed to the member/patient. Provider of service should write off the patient responsibility that primary insurance applied.
If a child has primary and secondary medical insurance who settles the dispute when the primary decides the secondary should now be primary instead of secondary as they had been for several years now?
It's not at the discretion of the insurance company as to who is the primary or the secondary. It is the sole decision of the policy holder(you). They are a paid service and are there to serve you.. Correction: . No, it's not at the discretion of the policy holder. The primary coverage is based on… who's birthday comes first. For example, in this particular case, the child lives with his mother and stepfather, and the stepfather and the biological father both have him on their medical insurance policies. The father's birthday is in October and the stepfather's birthday is in December. So the father's insurance is primary, and the stepfather's insurance is secondary. These are the quidelines insurance companies use to determine which one is primary, and which one is secondary. (MORE)
As a provider i file primary insurance. do I have to also file secondary insurance after primary pays?
You should or you customer WILL be PISSED for having to do the leg work of getting the information of what the primary paid and getting it to their secondary.
yes, they will treat it as if the primary was a different company. You pay two premiums. If they do not, contact the DOI.
Answer It depends on the allowed amounts. Even if it does pay something it will never pay the entire copay.
Is it required to make a primary dental insurance adjustment if the dentist is a preferred provider before submitting a claim to secondary insurance?
You wait until both claims are received then write off the lesser of the two amounts
Put simply, yes, you can buy travel insurance or travel health insurance without primary insurance. That's just as well, as your primary insurance may not cover you (or cover you completely) when you travel overseas.
When a DPPO is primary coverage, the charges paid by the patient are based on the agreed DPPO discounted fees--not the DHMO schedule of charges. The dentist would bill the DPPO for the procedures performed. If the dentist is in the DHMO network, he or she would also get his or her regular capitation… payment for that patient. (MORE)
The answer to that question depends on a few things. 1. Group insurance policies are always primary over personal or self bought policies...ie You work for ABC company. You have insurance thru them (group policy) and you also pay for an individual or personal policy. Your policy thru ABC would be pr…imary 2. Government insurance (except for medicare) is always 2nd...ie Tricare, medicaid, and etc. 3. An active policy is always primary over a retiree policy. For example John retired from ABC company and has insurance thru them. He currently works for DCE company and has a policy thru them. The DCE policy would be primary and the ABC policy 2ndary 4. If you are retired and have medicare. Then medicare is primary but if you are actively working your group insurance would be primary. 5. When it comes to children the order is 1. Parent who's birth month comes 1st if both parents are born in the same month it goes by the day (the year doesn't play a role in this) 2. If parents are divorce it goes by 1. court order if not applicable goes by who has custody is primary this includes step parents. The step parent who has custody of a child, their insurance is primary. There are a few other rules when it comes to who is primary...when in doubt contact your insurance company (MORE)
If a person has two Medical insurances and the primary denies due to preexisting will the secondary pay?
It depends on a few things. If your primary insurance is say less than 2 years old, they can deny claims to determine whether the condition is pre-existing. If you have had the secondary policy longer/ or the pre-x period has already been satisfied, then they may pay the claim as secondary. As long …as the treatment is indicated as covered benefits in the policy. These cases are common when both spouses have covered each other on their jobs. And/or when a child is covered under both parents policies. There could be a coordination of coverage issue with the latter. (MORE)
Medicaid is always the payor of last resort. Before a Medicaid agency pays a bill for a Medicare beneficiary, they require documentation that Medicare has "adjudicated" the bill (i.e., decided whether to make payment and, if so, how much).
A supplemental or an indemnity policy will work in conjunction with your Major Medical policy, you may have to file the claims yourself though. The best place to look for an indemnity for good overall coverage is Homeland Healthcare.
Do you have to pay the medicare deductible if they are paying secondary to a primary insurance carrier?
Every covered life, whether utilizing Medicare as primary or secondary insurance is subject to the same, annual Medicare deductible.
It is usually written in an insurance policy if the policy is primary or secondary. If both policies have language that makes them secondary if other insurance is present then they may split the amount owed. State laws may change this.
We have Medicare and added on Anthem. Does that mean Medicare is primary (Paying 80 percent) , and Anthem is secondary?
No. If you have a deductible with your primary carrier, you will have to pay the deductible first before Medicare will pay anything.
Absolutely. I'm not sure what type of insurance you are talking about in particular but you are always required to tell insurance companies of other carriers that may have some liability in a claim. It is illegal to make money from a claim in this manner. Be very careful about items like this that c…an get you into a great deal of trouble with a felony charge of insurance fraud. (MORE)
Over the years the primary, secondary and tertiary have changed in the way that they are used. For example in the 1900 the primary sector was used more because people produced their own http://wiki.answers.com/Q/Explain_he_areas_of_growth_or_decline_in_the_primary_secondary_and_tertiary_classificat…ions# and had their own animals for meat, but as the years have gone on people started to trade the food that they produced and the animals they owned for other products. In 1993 the percentage of people working in the tertiary sector was 73.8%, and then this figure started to increase as the years past. In 1998 it was 75.0%, in 2000 it was 76.5%, in 2003 it was 78.7% and in 2005 it was 81.6%, but as the tertiary sector was increasing the primary sector was decreasing. In 1993 it was 2.2%, in 1998 it was 2.0%, in 2000 it was 1.7%, and in 2003 it was 1.4. The figure in 2003 did not change (MORE)
Within each policy there is a clause called the coinsurance clause which will spell out which policy will be primary and which is secondary. I assume that you are referring to health insurance and not any other type of insurance as this occurs mostly in health insurance cases. There are different me…thods of determining this so that is why I have to refer you to your specific policy. Some of the method can be: which policy started first, which policy owner has the earliest birthday during the year, and there are a few more methods. In any case the insurance carriers will determine which is primary. This will result in which policy pays first and which policy pays the remainder. The total paid by both companies can never exceed the amount of the bills so you cannot benefit no matter how many policies you have. It is illegal to profit from insurance payouts like this. (MORE)
What happens when your primary insurance does not have a hospital in network but your secondary insurance does?
File a claim with both companies. The companies will pat what they are supposed to pay.