Both of my son's medical insurers insist they are primary. What do I do?

Question

My son has two medical insurance policies:

1) A Cigna group policy offered by my employer to my entire family.

2) An Anthem/BCBS individual policy which I personally pay for. This policy is under my son's name, only for him.

Both policies think they are primary. I have called them both, and both say they are primary. I have told each of them that the other says they are primary, so I'm not defrauding anyone.

Now, I send a lot of claims manually from a provider that does not file for me. I haven't reached the deductible for either policy yet, but once I do, they may start double-paying me.

So, what do I do?

- Who do I file with first?

- Who do I send EOBs from the other to?

- How do I resolve this?

Answer 1

The anthem one is definately primary.  File everything with ANthem first, then Cigna second.  

But your problem is very, very common, and so is the reverse - NO ONE wanting to pay out at all, because they're pointing at the other guy as being primary.  You will spend long, long hours trying to coordinate benefits and get ANYTHING paid out here.

Answer 2

OMG... I had this same problem. I had a secondary policy for my son also.  The other poster was correct that each insurance carrier is passing the buck so they don't have to pay.  

How I solved this problem.... call your job's Cigna group policy administrator rep. Ask the rep if they have your son listed on a family policy with you. Hint: your policy info is in a nationwide database and can be looked up by both carriers.   When the rep says no... ask if she can give you documented proof that your son is not covered under the policy.

Then call the other carrier Anthem who you paid for out of pocket and explain you have documented proof that your son is not on your job's group policy with Cigna.  If Anthem insists that Cigna is the primary carrier for your son and refuses to cover the costs... go to the website for your state and look up the Dept of Insurance.  Go to the make a complaint page and file a formal consumer complaint against Anthem for not honoring your policy (which is a legal binding contract).  

Every insurance company is afraid of the state.  I found out when I used this method.  The department of insurance is very hard on companies who give consumers the run around and will quickly investigate.  Believe me one call from the state and they will move.

Good Luck.. I'd really like to know how you made out.