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Primary or 2ndry Ins?

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  • Melinda
    Ok, is anyone else very frustrated with this Obamacare insurance thing... with carrying children until they re 26? We had a 20 yr old pt come in for 4 visits
    Message 1 of 3 , Sep 10, 2012
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      Ok, is anyone else very frustrated with this Obamacare insurance thing... with carrying children until they're 26?

      We had a 20 yr old pt come in for 4 visits this year and presented HIS employer ins card UHC, for 2012 coverage. However, when his Dad came into pay his own bill today he presented a Regence Oregon ins card, for his son. I asked how long the policy had been in effect and he said "since birth." I told him that we also had UHC on file, through pt's employer and Dad said "well let's just make that primary." I told him we couldn't do that (by law) and it was up to
      the insurances to decide who is primary & if claims need to be reprocessed.

      I called both Regence & UHC and neither of them had any idea that there was other insurance.

      I had a patient a few mos ago. who came in and had no idea his Mom carried a policy on him and he was married & had a policy through his wife. Ins determined that because his Mom's policy had been in effect the longest her plan was primary & wife's policy was secondary.

      ARRRGGHHH!!!! Parents & children both have NO idea which plans are primary & secondary (not just in this case)!!!!! No clue! WE (provider's offices) have to inform them, once we figure it out, but it's getting them to inform us that's the problem. Patients / Parents all want the "cheapest plan" to be the primary insurance; regardless of what the laws state. 9 times out of 10, most of them don't know which is primary or secondary. VERY FRUSTRATING!!! Because then
      it's up to doc's offices to fix it. How stupid and time consuming.

      So my question to the forum...in my above scenario for today, which do you think is primary & secondary and why?

      Also, is there some clarification on the web were I can get some documentation on this? (i.e., birthday rule, etc.)
      http://www.insure.com/articles/healthinsurance/birthday-rule.html

      Thanks for letting me vent!

      Melinda Brown, CMBS
      Ins Biller
    • Sunne
      Melinda, I would submit the claim to the insurance that has been in effect the longest.  The three companies will have to determine who is primary.  I
      Message 2 of 3 , Sep 12, 2012
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        Melinda,

        I would submit the claim to the insurance that has been in effect the longest.  The three companies will have to determine who is primary.  I understand how you feel; patients can really cause unnecessary stress sometimes.  Patients who know next to nothing about their insurance coverage is and has always been a problem. 

        The insurance of the parent who's birthday comes first in the year is primary.  You might try the insurance company's website for documentation of the birthday rule.

         
         




        >________________________________
        > From: Melinda <melindadocsmith@...>
        >To: MedicalBillers@yahoogroups.com
        >Sent: Monday, September 10, 2012 8:30 PM
        >Subject: [MedicalBillers] Primary or 2ndry Ins?
        >
        >

        >Ok, is anyone else very frustrated with this Obamacare insurance thing... with carrying children until they're 26?
        >
        >We had a 20 yr old pt come in for 4 visits this year and presented HIS employer ins card UHC, for 2012 coverage. However, when his Dad came into pay his own bill today he presented a Regence Oregon ins card, for his son. I asked how long the policy had been in effect and he said "since birth." I told him that we also had UHC on file, through pt's employer and Dad said "well let's just make that primary." I told him we couldn't do that (by law) and it was up to
        >the insurances to decide who is primary & if claims need to be reprocessed.
        >
        >I called both Regence & UHC and neither of them had any idea that there was other insurance.
        >
        >I had a patient a few mos ago. who came in and had no idea his Mom carried a policy on him and he was married & had a policy through his wife. Ins determined that because his Mom's policy had been in effect the longest her plan was primary & wife's policy was secondary.
        >
        >ARRRGGHHH!!!! Parents & children both have NO idea which plans are primary & secondary (not just in this case)!!!!! No clue! WE (provider's offices) have to inform them, once we figure it out, but it's getting them to inform us that's the problem. Patients / Parents all want the "cheapest plan" to be the primary insurance; regardless of what the laws state. 9 times out of 10, most of them don't know which is primary or secondary. VERY FRUSTRATING!!! Because then
        >it's up to doc's offices to fix it. How stupid and time consuming.
        >
        >So my question to the forum...in my above scenario for today, which do you think is primary & secondary and why?
        >
        >Also, is there some clarification on the web were I can get some documentation on this? (i.e., birthday rule, etc.)
        >http://www.insure.com/articles/healthinsurance/birthday-rule.html
        >
        >Thanks for letting me vent!
        >
        >Melinda Brown, CMBS
        >Ins Biller
        >
        >
        >
        >
        >

        [Non-text portions of this message have been removed]
      • josette sylvan
        FIRST & FOREMOST OBAMACARE HAS ABSOLUTELY NOTHING TO DO WITH THIS AGE OLD SITUATION, FROM THE BEGINNING OF INSURANCE TIME. (Patients who know next to nothing
        Message 3 of 3 , Sep 13, 2012
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          FIRST & FOREMOST OBAMACARE HAS ABSOLUTELY NOTHING TO DO WITH THIS AGE OLD SITUATION, FROM THE BEGINNING OF INSURANCE TIME.
          (Patients who know next to nothing about their insurance coverage is and has always been a problem.) it is our job to verify eligibility etc. you cant be responsible for something no one told you anything about. when you do find out about it, then it is still your job to deal with refunds, takeback, resubmit with proof of file time etc.


          NOW: RULE OF THUMB
          Patient can have as many insurance policies as they can afford
          The insurance of the parent who's birthday comes first in the year is primary
          Insurance companies will dispute & determine who is 1st, 2nd or 3rd based on thier rules & policies
          **NEVER RELY ON A PATIENT TO TELL YOU WHAT IS OR ISNT ABOUT AN INSURANCE POLICY**







          To: MedicalBillers@yahoogroups.com
          From: melindadocsmith@...
          Date: Tue, 11 Sep 2012 00:30:35 +0000
          Subject: [MedicalBillers] Primary or 2ndry Ins?





          Ok, is anyone else very frustrated with this Obamacare insurance thing... with carrying children until they're 26?

          We had a 20 yr old pt come in for 4 visits this year and presented HIS employer ins card UHC, for 2012 coverage. However, when his Dad came into pay his own bill today he presented a Regence Oregon ins card, for his son. I asked how long the policy had been in effect and he said "since birth." I told him that we also had UHC on file, through pt's employer and Dad said "well let's just make that primary." I told him we couldn't do that (by law) and it was up to
          the insurances to decide who is primary & if claims need to be reprocessed.

          I called both Regence & UHC and neither of them had any idea that there was other insurance.

          I had a patient a few mos ago. who came in and had no idea his Mom carried a policy on him and he was married & had a policy through his wife. Ins determined that because his Mom's policy had been in effect the longest her plan was primary & wife's policy was secondary.

          ARRRGGHHH!!!! Parents & children both have NO idea which plans are primary & secondary (not just in this case)!!!!! No clue! WE (provider's offices) have to inform them, once we figure it out, but it's getting them to inform us that's the problem. Patients / Parents all want the "cheapest plan" to be the primary insurance; regardless of what the laws state. 9 times out of 10, most of them don't know which is primary or secondary. VERY FRUSTRATING!!! Because then
          it's up to doc's offices to fix it. How stupid and time consuming.

          So my question to the forum...in my above scenario for today, which do you think is primary & secondary and why?

          Also, is there some clarification on the web were I can get some documentation on this? (i.e., birthday rule, etc.)
          http://www.insure.com/articles/healthinsurance/birthday-rule.html

          Thanks for letting me vent!

          Melinda Brown, CMBS
          Ins Biller






          [Non-text portions of this message have been removed]
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