What a second health insurance covers..Does a second health insurance cover the co-payment from the first one?

Answer 1

Generally, if the first insurance carrier pays on a claim, there is still a co-payment left that will be paid by the secondary insurer. If a patient has Medicare as a primary insurance carrier, it will pay 80% of the allowed amount, leaving 20% to be paid by either the patient or secondary carrier. Patients who must be on their toes are those who have an HMO or PPO as their secondary carrier. These patients MUST have a referral from their primary doctor in order to have the secondary carrier make a payment. Since referrals can not be backdated, it is up to the patient to make sure they get the referrals before seeing a doctor or having a procedure done. If you are planning surgery, remember that you will need a referral for the physician, anesthesiologist, and hospital. Forgetting any one of those might leave you with a large bill, even if it is only 20% of the medicare allowable. The same applies for patients without medicare, but are carriers of two different coverages (such as two working spouses who have coverage under both). Be aware of which doctors will accept both of your insurances, and be an advocate for yourself if a bill is not paid, or is paid incorrectly. Many doctors offices will not spend the time or energy to get the bill paid on your behalf...... they just send you the bill and let you deal with it.