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?

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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.
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What is the difference between an HMO and PPO?

(HMO) Health Maintenance Organization - A health care payment and delivery system involving networks of doctors and healthcare institutions. It offers consumers a comprehensive range of benefits at one annual fee (often with co- payments or deductibles that vary from service to service) but they can (MORE)

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 (MORE)

Can you designate which of your insurance is secondary and which is primary?

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 (MORE)

What is the difference between an HMO and a PPO?

This is an important difference to understand. If your healthcare options include the choice between an HMO and a PPO, you will need to determine whether or not your trusted doctors participate and, if not, if you will be able to afford your share of their fee if you opt for a PPO. Some women feel t (MORE)

Can the secondary insurance provider deny a claim that was not filed with the primary insurance provider first?

\n. \n Answer \n. \nLet 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 (MORE)

What are the differences between EPO PPO POS and HMO insurance plans?

Not sure about the first one. A PPO is a Preferred Provider Organization. Usually, it works like this: The insurance company provides a list of health-care providers who are in its network. If you use one of them, you pay a nominal co-payment, much as you would with an HMO. The doctor agrees to ac (MORE)

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 (MORE)

Primary and secondary health insurance?

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 (MORE)

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 (MORE)

If insured by your employer and your spouse's employer which is the primary insurance?

Your insurance through your employer is your primary insurance, and your spouse's primary insurance is through his/her employer. If both husband and wife are insured on both insurance policies, then you have primary and secondary coverage. But you will still have to pay any deductibles and co-pays b (MORE)

What is difference between PPO and HMO?

Preferred Provider Organization (also known as a PPO) is a managed care system that offers members health benefits and medical coverage based on a specific structure and network of medical professionals and facilities. PPOs are commonly sponsored by employers or insurance companies and help subsidiz (MORE)

What is primary and secondary dental insurance?

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 (MORE)

Can an employee change health care plans HMO to PPO for example when the employer relocates the employee out of state and the plan like Kaiser is not available?

If the employer is the one that is relocating the employee to an area where they don't accept Kaiser's insurance, then I believe that you should be able to pay for your services/prescriptions upfront and then claiming it straight through the employer. You should check with your employer first, but t (MORE)

Are either one of these health insurance companies any good Pacificare HMO and United Care PPO I need feedback from people who have or were ever covered by these insurance companies?

I have found PacifiCare to be less than helpful. On many occasions they deny receiving billing from providers. The providers refile only to be told it is too late. I have documentation proving this on at least 3 different providers. I am still waiting payments from November of 08. In November and De (MORE)

Which is better-a ppo or an hmo healthcare plan?

The one that is better depends on your actual medical needs, and your desire for flexibility with the doctors that you see. In a HMO, you are restricted to a network of doctors, and typically there is no coverage if you go to an out of network doctor. In a PPO, you get more affordable coverage when (MORE)

You have employer provided health insurance but want to put your child on another health insurance plan. Do not want to buy family coverage through employer insurance provider. Can you do that?

Sure. You are not "required" (at least not yet) to cover either yourself OR your dependents on your employer's plan at work. In fact, you can often get a more cost effective plan (i.e., cheaper or more "appropriate" for your actual needs) by going with an individual health plan for your dependents ( (MORE)

What is an HMO insurance?

HMO (Health Maintenance Organization) is one of three managed care health insurance systems in the United States. An HMO is designed to offer financial support and medical treatment to plan members. Some managed care systems don't offer medical treatment themselves. Rather, they offer different leve (MORE)

How does a company move to providing employer-based health insurance if they are currently just giving employees checks to buy their own health insurance?

Easy. Call a local broker or benefits company. It doesn't cost you anything and they can match you up with the best plan for you. If you want to do it yourself, call the carriers for a quote. You'll need to provide them with an employee census. Keep in mind you'll need to meet certain participation (MORE)

If a child has primary and secondary medical insurance who settles the dispute when the primary decides the secondary should now be primary instead of secondary as they had been for several years now?

It's not at the discretion of the insurance company as to who is the primary or the secondary. It is the sole decision of the policy holder(you). They are a paid service and are there to serve you.. Correction: . No, it's not at the discretion of the policy holder. The primary coverage is based on (MORE)

You have an hmo insurance plan in Virginia your husband spends a lot of time in New York and is not covered by your hmo if you switch to a ppo will he be covered in N.Y. and if he is will it cost more?

Yes and Yes. . An HMO provides coverage for in-network providers only and a PPO plan will cover both in and out-of-network providers. That is the main difference between the plans. . However PPO rates are typically higher than HMO rates. . Also if using an out-of-network provider, reimbursement (MORE)

Can you combine a Dental HMO and a Dental PPO?

If you mean that you are covered under both types of policies and want to know whether you will receive benefits under both, you should know that each state has laws related to "coordination of benefits" which dictate which policy will pay 1st and which one pays some portion of any remaining cost. (MORE)

What happens if primary insurance is PPO and secondary insurance is HMO?

When a DPPO is primary coverage, the charges paid by the patient are based on the agreed DPPO discounted fees--not the DHMO schedule of charges. The dentist would bill the DPPO for the procedures performed. If the dentist is in the DHMO network, he or she would also get his or her regular capitation (MORE)

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 (MORE)

If you have health coverage through two different companies the one through retirement and one through current employer who is primary?

Both of you policies will spell out this in the "Co-ordination ofBenefits" clause. Most likely the oldest plan will be primary butsome go by the birthday of the person insured under the policy. Ifthe retirement benefit coverage is from your spouses policy and thecurrent employer is in your name the (MORE)

Does my employer have to provide health insurance me?

No. Not if the employer is not set up to offer it to any of his/her employees OR if the company does offer it and you are a 'Part-time employee' working under 35 hours a week OR if you are a 'Full-time employee' and have not worked for the company for 90 days.

How are primary and secondary insurance determined?

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.

Is a HMO insurance coverage usually more expensive than a PPO?

For the most part, no. An HMO is a type of managed care plan that focuses upon keeping the member healthy. It is a genre of "managed care", of which there are several models. The models differ mostly in the amount of choice that the member is given in using physicians of his/her choice, at least (MORE)

Which is better hmo health insurance or PPO?

"It's all about preference. Each type of insurance has its own benefits. It is better to stick with the one that meets your needs the most. Also, make sure to pick that one that you can afford."

How can one explain what HMO vs PPO is?

The major difference between HMO and PPO is the fact that HMO lets individuals choose doctors within a specific network, while PPO allows patients to choose their own health care provider.

Can you have a hmo and a ppo plan at the same time more specifically kaiser hmo through my employer and aetna ppo through my spouse's?

Technically yes, each of you will have your own primary plan andall claims for each will go through that plan first, but assecondary, the other plan will cover in areas where the hmo doesnot with provisions, each plan is different that way, but usuallyit gives more options for health care where to h (MORE)

Who is the best dental insurance PPO or HMO?

PPO and HMO, both are acceptable dental insurance. PPO dental insurance allows you to concern other dentist with some limitation coverage. HMO dental insurance provides expert dentist in their network to offer best treatment. You can choose any insurance plan which suits you the best.