Does having 2 medical insurances help ?

Question

I have my own medical insurance through my employer, plus I am also covered under my husband's medical insurance through his employer. Does it help to be covered under 2 such insurances ? Or does it hurt ? When I went in for a dental treatment I was told by my husband's insurance company that they were my secondary, and they had a non-duplication policy that allowed them to pay only equal or lesser than what the primary insurance company wud pay. Thus I ended up with a 500$ bill which I have to pay from my pocket now. So I am wondering if having 2 such insurances truly helps ?! Pls help with any information or experience that any of you might have had on similar accounts. Thanks in advance !

Answer 1

It depends. As you found out the hard way, sometimes there are exclusions to having two policies. Here's where it could benefit:

First of all, there's what they call "the birthday rule" - if your birthday comes first in the year, your plan is the primary. If your husband's birthday comes first in the year, his is primary. (Regardless of who is older. If he was born in January, and you in June - his plan is primary.)

Once primary and secondary plans have been established, you need to know what each one covers in relation to the other, and to make sure where there are non-duplication riders. For instance, if the primary plan doesn't cover routine care but the secondary one does, once the primary plan denies the routine care, it can be billed to the secondary plan. You have to bill the primary plan first - otherwise, there comes an issue called "coordination of benefits" which is where each plan points to the other and says "that one is responsible."

What you can do in this specific case is keep your reciepts and proof of payment and see about billing it to the secondary insurance yourself. Sometimes insurances give patients more leeway than providers about things like this. Call the secondary insurance yourself and ask. The worst they can tell you is sorry. (In which case, see about writing it off on your taxes!)

Good luck!!

Answer 2

It should help - the secondary insurance should pick up most, if not all, of what the primary didn't (excluding your deductible).

The dental office should have sent the bill to the primary company - yours - first. The remainder would then be billed to the secondary - your husbands. It doesn't sound like that's how it was billed. You must make sure that all your doctors, dentists, etc. know which insurance is primary.

Plus you must take into account the deductible on both insurance coverages.

For major dental work, insurance companies rarely pay more than 50% anyway, so it is possible that the bill was correct. Please check w/the dental office manager to ensure that they indeed have billed your primary.

Answer 3

You appear to have been hit by a "contribution" clause, which is fairly standard on many policies. This means the insurance company will only pay its share of the claim based upon the cover offered by other policies.

Say you have two policies. The first policy gives you $1000 of cover, the second $500. When it comes to your claim the insurance companies will look at their combined coverage ($1,500) and share the cost of your claim amongst them based on the percentages.

So insurer 1 will pay two thirds of your claim, insurer 2 a third. Less any excesses of course, which means you could end up out of pocket by having to pay two excesses.

This is because a principle of insurance is that you should not benefit from your insurance, only recover the costs that you are reasonably entitled to.

If you are looking at a second policy I would suggest talking to a broker about a policy that is designed to specifically cover the excess that you would pay. As it is the excess that is covered, and not the whole medical bill, the issue of contribution should not arise.

Answer 4

Not unless one of the policies was a supplemental type of policy that is secondary to the primary one. Health insurance operates on the principle of indemnity; which means that you will not be paid more than your cost for medical goods and services regardless of how many policies you have. Supplemental policies pay after the primary policy has paid all it will. For instance, if your primary policy has paid 80% of your medical expenses, then the supplemental policy would probably pay the remaining 20%.

Answer 5

It doesn't usually help. Unless one of the policies is medicaid, CHIPS, or other welfare based policies, most will have primary/secondary clauses (and your own policy will ALWAYS be primary) which leave you out of pocket for copays and deductibles, while you're still paying both premiums!!