What would you like to do?
Answer Let me tell you what happend to me. I hope that this helps. I used to be covered by two insurance companies. My primary insurance company was through the company that I worked with. My secondary was with the company that my husband works with. When a claim was filed with my secondary insurance company they wanted to know how much my primary insurance company paid for and until then they would not pay anything. So I had to submit to my primary insurance company and once they paid some then the secondary would. I hope that this helped:)
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That would be covered under the terms of your policy. In general that is what supplemental, (secondary) insurance is primarily for. Most "supplemental" plans pay …the 20% that Medicare didn't pay only AFTER seeing an "explanation of benefits" statement--i.e. proof that Medicare paid their part. If Medicare denies a service all together, the supplemental plan is often under no obligation to pay at all, as they are there to "supplement" Medicare, not take the place of it in cases of denial. This is especailly true if Medicare denies because the service was deemed "not medically necessary". So, in short, no. Medicare supplements often do not cover services if they are denied by the primary (Medicare).
With Primary and Secondary Insurance your primary denied your claim because it was over a year is your secondary obligated to pay?
Answer Yes, subject to the limits in their policy. Answer No. With most insurance policies, there is what is called a timely filing limitation. For my… company; contracted providers have 6 months, and non-contracted providers have 12 months to submit the claim. If your primary insurance received the claim within timely filing, you may have the option of submitting the claim to your secondary with proof that it was filed in a timely manner. If that doesn't work you can always appeal the decision with the secondary or for that matter the primary insurance company. Policy holders are not responsible for claims that deny for timely filing.
Are health care providers obligated to accept payment from a secondary insurance at their fee schedule when the provider does not participate with the the patient's primary insurance?
Answer It has been my experience that providers of health care are not obligated to accept secondary or even primary insurnace coverages if they are not un…der contract with that insurance company. I believe they are free to accept no insurance coverage at all and demand "cash" up front if they so desire. This would leave it your responsibility to sent the bill to your insurance(s) carrier(s) and get direct payment assuming they cover out of panel care. Some providers can not refuse you care even if you had no insurance but you would be responsible for the cost of care.
Answer As long as it is a covered expense by your secondary insurance and a claim has been filed with the primarty insurance then the answer is yes. The se…condary insurance will only cover the expense according to your plan.
Is it possible for an insurance company to deny your claim because you have a primary and they can not be a secondary?
Answer Conference the 2 claims reps together and let them Duke it out!
Answer States establish SOL's concerning any type of lawsuit other than one that would come under federal jurisdiction. The statute of limitations will vary from state …to state - check local law. Every claim should be made as soon as possible after the event, however, to preserve evidence of your position, keep information fresh, and avoid being accused in court of delaying. Consumers should assert their legal rights if they believe they have not been treated fairly. Bear in mind that insurance providers retain an "army" of attorneys. Insurance companies may deny a claim based on an erroneous understanding of the facts, or based on a conservative interpretation of coverage criteria when compared with the facts. The first step to countering a denial of claim is negotiation and assertion of your position. An insurance company will weigh the costs of payment of a claim against cost to them of contesting a claim, as well as the likelihood of success. An insurer will also consider how many other claims like yours may be pending, and may be hesitant to create a precedent. While the claim is a personal matter for you, an insurance company considers this a business decision. One should give serious consideration as to the personal cost and time of pursuing litigation as well as the financial expense. While it is not necessary to obtain legal counsel to negotiate a dispute, it may be cost effective, and may avoid litigation. Whether representing yourself or using an attorney, it is important to see how courts in your state have ruled on insurance claims under similar facts. Looking at that information early on can let you know how good a claim you have, and how much effort it is worth.
Are health care providers obligated to accept payment from a secondary insurance with whom they participate when the provider does not participate with the patient's primary insurance?
Yes they will have to accept payment from the secondary insurance, however they will have to bill the primary provider first. What ever the primary insurance …does not cover should be covered by the secondary insurance. However, it will depend on the service being provided and the contracted amount that each insurance has agreed to pay. If the primary pays more than the secondary would have paid -there may be a refund due. However, there may be co-pays and deductibles to be met with both insurance policies. There could also be write downs--- you should only pay the lesser amount the provider may have to take a loss if one insurance has a lower contracted amount
IF Patient primary insurance denied claim because provider is not contracted with them will secondary insurance pay on the claim?
You have had payments for claims recouped because the insurance company was secondary the primary insurance company is denying the claims recouped due to timely filing Is there anything you can do?
If your health insurance is thru your employer, have them contact their account rep. These issuse can be magicaly resolved when it is time to renew the company policy, if the …rep is informed thast the company will seek another provider should it not be taken care of.
Yes, and you want them to because if they are paid out of order then it will be a mess to correct.
If your primary insurance denies a claim for failure to have a referal will your secondary insurance pay the claim?
Read your policy
As a provider i file primary insurance. do I have to also file secondary insurance after primary pays?
You should or you customer WILL be PISSED for having to do the leg work of getting the information of what the primary paid and getting it to their secondary.
yes, they will treat it as if the primary was a different company. You pay two premiums. If they do not, contact the DOI.
Is it required to make a primary dental insurance adjustment if the dentist is a preferred provider before submitting a claim to secondary insurance?
You wait until both claims are received then write off the lesser of the two amounts
Follow up report that is sent to the insurance commissioner
Yes, it can be and no it may not be. You did not give enough information for a determination. Usually, the primary carrier pays their maximum, then the secondary carrier pays… some or all of the portion of the procedure that is left BUT not more than the claim itself or more than they would have paid if their contract was primary. Here are some reasons why it could be legitimate to deny your claim. You could have hit the limits of the secondary policy. There could be a provision in the secondary policy that it does not cover the procedure that you had or that says it does not pay anything if it is secondary. The latter is somewhat unusual but worth checking for. Did you ask the carrier why they denied it? If they do not point to a specific provision in your contract, ask them to. If they do not, your state Insurance Department should have a consumer representative that you can ask for help in determining whether it was legitimate for them to deny coverage.
Will your insurance be primary for your children even though your ex-husband provided insurance first and the decree states he has to provide the insurance?
Yes, it is possible that your insurance will pay before your ex-husband's no matter what the divorce decree states. Most insurers use what is called the "birthday rule". The …plan of the parent whose birthday occurs first in the calendar year is considered the primary (or first) payer for the children's needs. The other parent's plan pays second. You can talk to the plans about handling it differently. Or, you could consider dropping the children from your plan and banking the money you spent on premiums. It's expensive to cover the children on two plans.