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== == If secondary insurance denies coverage, YOU get to pay the bill. == ==

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Q: If primary insurance denies coverage and you have secondary who is responsible to pay the bill?
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What is meant by primary and secondary insurance coverage?

Primary insurance coverage is what is first used when a medical service is being rendered. This is what will be billed first. Secondary insurance is supposed to cover what the primary insurance does not.


Does secondary private insurance pay what primary private insurance will not pay?

Yes, if the secondary insurance plan covers it In the pharmacy (drugs) world of primary and secondary coverage, this is true.


If a patient has Medicaid coverage benefits and other health insurance coverage Medicaid would be primary or secondary?

Secondary.


Will a secondary insurance pay a portion or all of a prescription that a primary insurance will only pay part of because they will only pay for a lower dosage?

In most cases a secondary insurance would compensate coverage were the primary insurance does not. Exceptions apply to the prescription drug type and coverage limitations.


When a primary insurance only covers 50 percent what would secondary insurance cover?

What does the brochure or policy Evidence of Coverage for the secondary policy say?


Can you designate the primary and secondary insurance coverage and declare not to pay because of no out of pocket expenses?

Sure, why not?


Can you change your secondary insurance to primary insurance if your coverage is better with the secondary insurance?

In most cases no. You can not chage due to better coverage. 90% of insurance companies, if not more, have what is called a birthday rule. Meaning if you have dependant children on the policy the guardian who was born first (or who is older) is the primary carrier for the dependant children and the younger of the two guardians is the secondary carrier. If you were to have coverage through yourself and a spouse you would be your own primary, as would your spouse be their own primary. If you are the carrier for both insurances then it would all depend on your plan provisions and restrictions, in which case you would have to question each insurance company as to how they would handle determining what insurance is primary and what insurance is secondary.


Is primary insurance copays covered under secondary insurance?

Depending on your coverage, your primary insurance will cover 80% of your charges, minus your deductible (if not already met). Your secondary insurance will pick up the remaining 20% co-insurance and your co-pay, if you have one.


What is a primary policy?

The concept of a "primary policy" can best be understood when there exist two or more insurance policies that arguably provide coverage for the same occurrence. The "primary insurance" is the policy that is first responsible for the payment of claims. A good example might be when a state requires that the owner of a motor vehicle to maintain what of often called "personal injury protection coverage" (a/k/a "no fault coverage"). That type of insurance pays a percentage of the injured insured's medical expenses and/or lost wages regardless of fault for the collision. If the injured insured also has major medical or hospitalization insurance, a primary/secondary insurance scenario develops. State statutory law or interpretative case law will dictate which is primary and which is secondary, but typically, the coverage specific to the occurrence (e.g. the auto-related insurance) will be primary until benefits are exhausted. Primary/secondary insurance situations may also develop when insurance is required to be maintained by the terms of a contract between two or more parties. Often, the contract specifies which (or whose) insurance will be primary.


Difference between primary and Secondary commercial claims?

There is one major difference between these types of claims. When a person has two different insurance carriers, one of them is designated as the primary coverage and the other as the secondary. The primary insurance should be billed first and normally pays the bulk of the bill. The secondary insurance gets billed for the remainder of the bill which the primary insurance did not pay for.


What is the difference between primary and secondary commercial claims?

The primary coverage is provided under the plan provided by the employer. Secondary coverage is usually a result of being covered as a dependent under someone else's health insurance plan.


Can a wifes maternity expenses be covered by the husbands insurance if her insurance does not have coverage?

If you both have coverage the wife's policy will be primary, and the husband's will be secondary - provided the wife is covered under the husband's policy. Submit the unpaid claims to the secondary carrier.