Can the secondary insurance provider deny a claim that was not filed with the primary insurance provider first?
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 M…edicare 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). (MORE)
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 r…eceived 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.\n. \n. \nPolicy holders are not responsible for claims that deny for timely filing. (MORE)
If a medical claim is denied because the provider did not file in time is the patient responsible for payment?
Check out this page where Medicare talks about providers being responsible for billing errors if it's their fault http://www.cms.hhs.gov/manuals/13_int/a3700.asp CA Civil Code # 3517. No one can take advantage of his own wrong. 3520. No one should suffer by the act of another. 3526. No man is respon…sible for that which no man can control. 3529. That which ought to have been done is to be regarded as done, in favor of him to whom, and against him from whom, performance is due. 3533. The law disregards trifles. I would say no. I'm looking though for the documentation. Here's what I have so far.... Q52. How do my PPO benefits work? A52. We have established a network of "Participating Providers". These providers are called "participating" because they have agreed to participate in our preferred provider organization program (PPO). . Receiving services from the Blue Cross PPO Provider network can substantially reduce your out-of-pocket costs. These lower costs are due to negotiated rates that Blue Cross PPO Providers have agreed to accept. These providers SHOULD file claims to Blue Cross for our members, then bill you for the remaining portion of their eligible charges. http://www.bluecrossca.com/pdf/faq/sg_member_faqs_ppo_plans_123002.pdf For more info see www.SteveShorr.com I checked with upper management at Blue Cross - here's their answer Claims submitted by Participating providers after their contractual timely filing period are denied as a provider discount amount. The member is not responsible for these services. There may be instances where a provider does bill the patient for this denial in error. When this occurs, the patient should either contact the provider and remind them this is a provider discount based on the EOB they received from Blue Cross or contact us directly and advise the provider is attempting to bill the member. In the later situation, we will then work with the provider to resolve the matter. No the patient can not be responsible . It should be the providers writeoff. (MORE)
If you have insurance through two current employers and the primary is an HMO can you decide to select a provider from the secondary PPO?
IMHO Yes CA Insurance Code 10270.98, but you would only get paid from the HMO Group disability (Health Insurance) policies may provide, among other things, that the benefits payable there under are subject to reduction if the individual insured has any other coverage (other than individual policies …or contracts) providing hospital, surgical or medical benefits, whether on an indemnity basis or a provision of service basis, resulting in such insured being eligible for more than 100 percent of the covered expenses. www.steveshorr.com (MORE)
If a car was stolen and insurance denies the claim can the leinholder file against the insurance and collect?
Generally yes, it is called subrogation. Depending upon the circumstances as to WHY to coverage did not apply.
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 . \nIt has been my experience that providers of health care are not obligated to accept secondary or even primary insurnace coverages if they are not under contract with that insurance company. I believe they are free to accept no insurance coverage at all and demand "cash" up front if th…ey 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. (MORE)
Answer . \nAs 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 secondary insurance will only cover the expense according to your plan.
Secondary medical insurance is a second level of insurance coverage. Under most circumstances, the two policies are independent of each other. One policy may pay for a service while the other may not. The primary policy must pay first, then the secondary. The choice of which policy is primary or sec…ondary is established by a shared rule between insurance companies. It is not the policy holder's choice. Examples of Primary/Secondary coverage: A husband and wife both work and carry the medical insurance offered by their respective employers. The husband adds his wife to his policy. The wife adds her husband to her policy. Under most circumstances, the husband's plan would be his primary policy and his wife's plan would be his secondary policy. In like manner, the wife's plan would be her primary policy and her husband's plan would be her secondary policy. (MORE)
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 yo…ur 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. (MORE)
If the father is primary based on birthday and the mother is secondary is it legal for the mother to use her insurance as primary by not telling the provider about the father's insurance?
Answer . No, it's fraudulant. It's not practical, the secondary insurance should pay the remainder of the cost the primary insurance doesn't cover.
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 amou…nt 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 (MORE)
The subscriber whose birthday comes first in the year is primary. The year is not considered. So a subscriber with a January 1 birthday is primary over the subscriber with a January 2 birthday. Hope this helps.
You could have two insurance companies pay the same medical bill or claim for a date of service through a process of subrogation where the first insurance company determined by the effective date of coverage will pay their portion of the bill and the second insurance company will pay the balance. Th…is process is called coordination of benefits. Secondary medical insurance is a second level of insurance coverage. Under most circumstances, the two policies are independent of each other. One policy may pay for a service while the other may not. The primary policy must pay first, then the secondary. The choice of which policy is primary or secondary is established by a shared rule between insurance companies. It is not the policy holder's choice. Examples of Primary/Secondary coverage: A husband and wife both work and carry the medical insurance offered by their respective employers. The husband adds his wife to his policy. The wife adds her husband to her policy. Under most circumstances, the husband's plan would be his primary policy and his wife's plan would be his secondary policy. In like manner, the wife's plan would be her primary policy and her husband's plan would be her secondary policy. Secondary insurance should not be confused with supplemental insurance. Supplemental policies usually abide by the primary insurance guidelines. If the primary allows the charge, the supplemental will allow the charge. Most supplemental policies cover the charges you would normally pay out of pocket. For example: A Medicare supplemental policy would cover the 20% coinsurance left over after Medicare pays 80% of the allowed amount. (MORE)
Is a provider RESTRICTED BY LAW FROM BILLING A PATIENT IF THE PATIENTS INSURANCE CARRIER DEIES THE CLAIM PER timely filing agreement?
Yes per the provider contract, they are required to file claims to the insurance carrier within specifiec time periods. The provider can NOT bill the patient if they have not done so.
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.
When you have a primary and secondary insurance will the co-pay from your primary insurance be paid by the secondary insurance?
I have insurance paid for by my employer (primary) and through my husband's employer (secondary). In my experience, I have never had to pay the copay required by my primary because it is covered by my secondary. When I first got married, 2 years ago, I still paid the copay, but the doctor's office w…ould always send me a check for the copay a month later because the secondary paid it. (MORE)
This is directly from the Medicare and You 2009 Book:. When you have other insurance, there are rules that decide whether Medicare or your other insurance pays first. The insurance that pays first is called the "primary payer" and pays up to the limits of its coverage. The one that pays second, cal…led the "secondary payer," only pays if it covers any of the costs left uncovered by the primary coverage.. If you have other insurance, tell your doctor, hospital, and pharmacy so your bills get paid correctly. If you have questions about who pays first, or you need to update your other insurance information, call Medicare's Coordination of Benefits Contractor at 1-800-999-1118. TTY users should call 1-800-318-8782.. You can view the details here:. http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf (MORE)
If a husband and wife both have dental insurance through their employers, the employee's insurance is primary when the employee is the patient, and it must pay it's benefits. The spouse's insurance is secondary, and will only pay once the primary insurance has paid. Depending on how the policy is wr…itten, sometimes the secondary insurance will pay any residual fees up to the annual maximum. Sometimes the secondary insurance only pays if their fee schedule allows higher fees than the primary insurance. This assumes that each spouse is named as a dependent on each other's policy. Ask the insurance coordinator at your dental office to what benefits are available between the two policies. (MORE)
If secondary agreed upon insurance is lower than the primary insurance agreed upon price which one can the provider bill the paitent?
Primary has to process and pay claims first then secondary will process and pay leftover expenses according to their policy provisions. The secondary sometimes excludes payment towards a primary policy deductible.
When you see an out of network or non contracted provider, it's you responsibility to make sure the claim is filed in time.
Family clinic accepted copay and claimed to be an in network provider. Insurance company denies claim because clinic IS NOT in the network. Can I dispute the bill for clinic's misrepresentation?
I did and finally, took about 3 months and finally it was PAID. I called the place several times and called Schalder Insurance and they finally paid it. Just be patient and keep records documented!
Call the insurance company and tell the representative that you want to file a claim. You will be given instructions. You will have to complete a claim form that the insurer provides, and at a minimum, submit a certified copy of the death certificate. The insurer may or may not conduct a further inv…estigation, or request additional documentation. (MORE)
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
Our practice is considering not filing secondary insurance claims. Are there consequences to the practice?
Yes, if you are contracted with the secondary payor, PPO contract, HMO contract, etc, you are bound by your contract to bill the plan
If a person has two Medical insurances and the primary denies due to preexisting will the secondary pay?
It depends on a few things. If your primary insurance is say less than 2 years old, they can deny claims to determine whether the condition is pre-existing. If you have had the secondary policy longer/ or the pre-x period has already been satisfied, then they may pay the claim as secondary. As long …as the treatment is indicated as covered benefits in the policy. These cases are common when both spouses have covered each other on their jobs. And/or when a child is covered under both parents policies. There could be a coordination of coverage issue with the latter. (MORE)
If the provider is out of network or not contracted with the secondary insurance, they do no have to bill the secondary and the patient is responsible for the balance (if any) owing
It is usually written in an insurance policy if the policy is primary or secondary. If both policies have language that makes them secondary if other insurance is present then they may split the amount owed. State laws may change this.
Generally Yes. Many insurers will decline your application if you can not prove that you have not had a lapse in coverage. If the new Insurer issued you a policy with the stipulation that you would provide them a copy of your current or previous policy at a later time. They can also cancel your p…olicy or they can consider you a higher risk and charge you a higher rate if you fail to provide the promised information. If you have had a lapse in coverage you should just be honest with the new insurer upfront to avoid an embarrassing situation later. (MORE)
Fortis insurance provides healthe insurance. They give free quotes and have a variety of health insurance packages that fit your preference. They offer individual health insurance as well as student insurance
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Yes, Tesco does provide insurance for your pet. They offer insurance for cats, kittens, dogs, and puppies. I am not sure if they offer any for any other exotic animals.
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Alfa insurance includes insurce for home and auto. Plans can be customized to meet individual needs to cover disaster and theft.
In researching this I was unable to come up with any insurance company that was named Campervan insurance. There are many others that provide comprehensive insurance services but CamperVan is not one of them.
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It depends. The first question to be answered is whether the medical provider has negotiated a contract with that insurance company. If not, then the secondary is responsible for 100% of the balance left by the primary--no adjustments allowed. The entire balance must be paid by either the insurance …company, the patient, or any combination of the two. It's different if there is a contract in effect with the carrier. Nowadays, many insurance companies process those claims in any one of several ways. They can compute how much they would have allowed (the total of ins resp + pt resp) had they been primary. Having done that, they'll subtract the amount pd by the primary and pay the balance--if there is one. If the primary had paid more than the secondary would have allowed had they been primary, the secondary may not pay anything and the balance left would have to be adjusted off. Sometimes the secondary doesn't consider what the primary paid at all, and both companies will pay as primary..it can make a difference whether the other insurance that is listed as primary is an individual or a group policy; and the same for the secondary. Group plans trump individual plans. When they both pay as primary, and neither insurance has processed the claim incorrectly and the provider has now ended up with a legitimate credit balance on the claim, the provider has 3 choices at that time. They can refund the balance to the insurance plan that created the credit balance; they can send the overpayment amount to the patient; or they can keep the money and deposit into their account. (MORE)
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 pa…id 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. (MORE)
If it is a group health insurance plan -- through your employer -- go to your HR person or your manager. They can get in touch with the insurance broker who sold them the plan. If it is an individual plan -- one you bought on your own -- go to the broker who sold it to you. Failing either of tho…se, your state may have a consumer assistance department, within its insurance regulatory bureau. Go to your state government website and search for "health insurance consumer assistance." Good luck! (MORE)
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 child…ren'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. (MORE)
Admiral Insurance is part of the Admiral Group and is a car insurance company. Admiral insurance mostly focuses on younger clients who traditionally would have higher premiums on car insurance. They also mostly focus on the area of London, Southeast England, and Scotland.
An example of a case against a health insurance provider is the death of a child following a doctor incorrectly prescribing a surgery. The small claims case is attempting to pay for the costs of the visitation of a infertility clinic and the birth of another child equaling $7200 dollars.
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Are primary and secondary insurance claims are filed simultaneously to ensure prompt payment to the medical practice?
In general this is true. However, the insurance policies usuallyhave "coordination of benefits" provisions which explain whichpolicy pays first and under what circumstances. There are sometimesalso statutes (laws) that dictate the order of payment. A goodexample of this is when one is injured in an …auto collision and hasboth personal injury protection and/or medical payments coverageand health insurance. The companies will coordinate the payment ofbenefits as between the policies. (MORE)
What notification is sent from the insurance carrier to the patient and the provider after an insurance claim has been processed?
The Insured Person will receive an EOB (Explanation of Benefits) from the insurance company which explains the payment by the insurance company, the allowed charge based on contract rates with the provider, and the remaining amount if any that is due from the patient to the provider.