Primary and secondary insurance questions - most efficient way to be reimbursed?

Question

I have a child with Autism that has two insurance plans.

The primary insurance plan does not cover Autism therapy.

The secondary insurance plan does cover Autism therapy.

The Autism therapy provider is out of both networks.

The provider bills me weekly for services, and I have to send claims to insurance. What is the most efficient way to file that will minimize the time before I am reimbursed. Specifically:

- Do I have to be refused by the primary before filing with the secondary?

- What recourse do I have if the primary insurer is slow to refuse, causing me to be late or miss my deadline for filing with the secondary policy?

Answer 1

Well the most efficient way to file to get the claim processed sooner is to either fax, or send the claim via certified mail. If the provider will file it for you, you can also see if the provider will file the claim electronically. They'll need the insurance company's payor id to do that, and some providers don't have the capability of doing that.

You do have to have the denial from the primary carrier before the secondary carrier will pay. If you submit a claim to your secondary carrier, without an explanation of benefits from the primary, they will deny your claim.

Which brings me to your last question. As long as you file in time (even though we don't have all of the information we need to actually pay the claim) it won't exceed your filing limit. So if you see that your primary carrier isn't going to pay on time, go ahead and submit the claim to your secondary carrier, even though you know they'll deny. Once the primary carrier finally pays, submit that explanation of benefits to your secondary carrier, and they will process your claim.

Hope this helps!

Answer 2

1) yes it has to be filed and refused by your primary FIRST, then you have to send the EOB to the secondary. they absolutely WILL NOT process the claim with out the EOB.

2) you typically have 12 months to file a claim before it will be denied for timely filing. some insurance companies will allow 18 months. i find it unlikely that it is taking your primary a year and a half to process a claim.