If you have two insurances...?

Question

We have two medical insurances on our children. Should there still be a copay? Should having 2 insurances cancel out the copay?

Well, sometimes the Dr says I have to pay a copay, other times I don't and this is from the same place? Then some specialist ask for a copay and some say with 2 I don't need to. And Aetna and BCBS have been no help whatsoever.

Answer 1

only if you can get the second insurance to cover the copay (but they usually don't)

Answer 2

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RE :If you have two insurances...?
We have two medical insurances on our children. Should there still be a copay? Should having 2 insurances cancel out the copay?
Update: Well, sometimes the Dr says I have to pay a copay, other times I don't and this is from the same place? Then some specialist ask for a copay and some say with 2 I don't need to. And Aetna and BCBS have been no help whatsoever.
Follow 11 answers

Answer 3

It depends on which insurence is primary and which is secondary. I know from having worked in medical billing for over twelve years, that BCBS sometimes covers copays from Aetna, but not the other way around.

Most insurence coverages will use a "birthday rule" meaning whomever is older, you or your husband, that insure would be primary if the coverages are similar.

You should still ALWAYS expect to have to pay your copays at time of service, regardless. If one of the insurences covers it in a later payment, then it's a bonus to you and you should recieve a refund from your physicians billing department.

ALWAYS check your Explaination Of Benefits that is mailed to you from your insurence companies after each physician visit!
AND ALWAYS make sure your physicians office files with the secondary coverage! Some phyisicians actually forget that a family has secondary if it's not medicare.

Answer 4

In many places, you pay the copay on the primary plan, and then submit proof of payment of the copay and anything else not covered by the primary plan to your secondary plan, with a copy of the original bill or Explanation of Benefits and wait to be reimbursed. If the doctors do that, they run into problems called Coordination of Benefits - where each insurance points to the other and says "That one is the primary" - it is not cost effective for the doctor's billing staff to fight out which insurance covers which things. It's also your responsibilty to make sure things are submitted to the secondary plans - because not everyone has secondary insurance, and many practices are large, so it's impossible for billing staff to know who has secondary and who doesn't.

You also have to make sure it's clear which insurance is primary and which is secondary - both with the doctor's office AND each insurance. That will ease any Coordination of Benefits issues. (To figure out which one is primary, you have to use the "Birthday Rule" - which means, whomever's birthday comes first in the year, regardless of who is older, THAT is the primary plan. All insurances go by the Birthday Rule - to eliminate people using the better plan as the primary and screwing the other plan.)

Answer 5

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RE If you have two insurances...?

We have two medical insurances on our children. Should there still be a copay? Should having 2 insurances cancel out the copay?

Answer 6

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RE If you have two insurances...?

We have two medical insurances on our children. Should there still be a copay? Should having 2 insurances cancel out the copay?

Answer 7

Usually the secondary insurance will cover copays, deductibles, coinsurance, etc... whatever the primary isn't paying. A secondary carrier may not cover something outside of the guidelines of your primary carrier.

But you should either read your plan descriptions to make sure that they don't have an exclusion in regards to that. Or you can call your secondary carrier and ask them if they'll cover it.

Every company and plan is different. If either of them is an HMO, that's another animal. It's always best to get the answer straight from them instead of having surprise bills later.

Answer 8

It's possible that one insurance is "primary" and the "secondary" insurance will pick up co-pays. I had a situation like that years ago, with a special needs child - private insurance with deductible & co-pays, and a special state insurance policy through the government that picked up all the copays and deductibles.

But this varies - it's not a guarantee that two policies means you don't have co-pays! Sometimes they work together, sometimes they don't.

Answer 9

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Answer 10

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