How many simultaneous medical insurance policies can I carry?

Question

Assume

a.) Husband carries medical insurance through work that covers both husband and wife

b.) Wife carries medical insurance though work that covers both wife and husband

Partner goes to doctor; which policy covers billing? Can a.) cover the visit, medication while b.) covers the co-pays? to net a "0" bill?

Answer 1

Your insurance is primary for you, his is primary for him. If he is being treated or recieving treatment for something that his insurance doesn't cover, his insurance will have to be billed for denial, then yours will be billed with that info for payment. Make sure you follow whatever rules needed (pre-certification, authorization) for whichever insurance that will ultimately cover.

EDIT:You may or may not have a -0- bill. That depends on what the coordination of benefits clause is for the secondary insurance. Read it. If they normally pay 80% for a service, and the primary insurance pays that, they may not pick up the balance.

Answer 2

You will need to file a COB (Coordination of Benefits) with each of the companies, letting them know about the other.  They will sort out who pays what.  As Lori stated, yours is primary for you and your husband's is primary for him.  

Sometimes the secondary company will pick up the copays and deductibles and sometimes the policy language won't allow for that.  Check with each company to see what they will do regarding the amount not covered by the primary company.

Answer 3

You can have dual coverage. Its quite common. BUT, having 2 policies does NOT mean you will pay $0. Call your spouses plan, and ask how they pay as secondary. It can be quite complicated, so ask.

You MUST report you have two plans. Failing to do so is considered fraudulent. Your insurance if offered through your/your spouses employer, they could terminate your health insurance based on your failure to disclose other coverage. If the wrong carrier pays services as the primary insurance, and should not have, they will eventually find out. & then, they will request refunds from the doctors & hospitals. Docs & hosps have a limited amount of time to file claims against your health insurance. If that time frame lapses, and the plan that is truly primary never received a claim, it becomes YOUR financial responsibility.

Your own plan, through your job covers you as primary. You do not get to choose which plan pays primary.