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If the primary insurance allows more than the secondary insurance what would the secondary insurance pay?

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2012-05-02 16:41:03
2012-05-02 16:41:03

Secondary insurance will not pay the claim but the remaining charges should not be billed to the member/patient. Provider of service should write off the patient responsibility that primary insurance applied.

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Yes, you can. The other insurance would be primary though and the Medicaid secondary.


If you have insurance through your employer, and you are the policy holder,(the insurance is in your name) this insurance will be primary for you, and your spouses insurance policy will be secondary. The insurance policy thru your spouse's employer, (your spouse is the policy holder, or the insurance is in their name), this would be primary for your spouse, and your policy would be their secondary. Here's the phamplet from Medicare http://www.medicare.gov/Publications/Pubs/pdf/02179.pdf


The answer to this question depends on what kind of secondary insurance you have - is it a group health plan? Is it a supplement? If Medicare is primary, there are still deductibles, copays, coinsurance that would need to be satisfied by your secondary insurance. Based on your question, I'm assuming that you have a group health plan with a copayment as your secondary insurance. If so, then yes, you would pay your copayment but it would not exceed the part B deductible.


Medicare becomes the primary insurance if you drop your employer insurance. Up until you drop your employer insurance, Medicare would be your 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.


We have Medicare and added on Anthem. Does that mean Medicare is primary (Paying 80 percent) , and Anthem is secondary?


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:) * Yes. A claim must always be made with the primary insurer first.


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.


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 would always send me a check for the copay a month later because the secondary paid it.


Yes, If medicare pays more than the secondary insurance allows for a charge, the secondary insurance pays nothing. The balance is written off to a contractual allowance that is agreed upon between the provider of service and the insurance company via contract.


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


Their insurance would be primary and your insurance would be secondary, generally speaking.


Yes, you can have a secondary beneficiary on your life insurance policy. If the primary beneficiary is no longer living when you pass away, the secondary beneficiary would receive the proceeds from your life insurance policy.


Their insurance would be primary and your insurance would be considered secondary when filing a claim.


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.


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.


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. This 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.


Is the patient responsible for deductible and coinsurance if primary insurance paid more than secondary would have allowed.


In regards to life insurance, contingent usually means secondary. For example a contingent beneficiary is a secondary beneficiary, not the primary beneficiary. The contingent beneficiary would receive the proceeds from a life insurance policy if the primary beneficiary were not alive when the insured person dies.


Only one can be the primary and the other the secondary. Choose the best for your primary and the lesser coverage for your secondary. With 2 insurance policies, you shouldn't have to pay for anything, unless the healthcare isn't included in either policy.


When a patient has primary and secondary insurance plans and there is a CO Bcarve out clause on their secondary plan this is what happens. Primary pays their amount and secondary subtracts primary's payment from what they were suppose to pay and pays the difference. Example: Primary pays 50% of a filling which cost $100.00 and secondary pays 80%. Primary pays $50.00, secondary would pay $80.00, therefore, secondary would only pay $30.00 of the remaining $50.00. It is a very confusing issue and I have been in dental for over 25 years and I still have a hard time explaining this to patients.


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 you have medicare and you are a dependent on your spouses medical insurance policy then you would be primary under your spouse and Medicare would be secondary payor. There are a few circumstances where Medicare would be primary but very few (your spouse is covered under COBRA, the group is less than 20 members, or you have end stage renal disease.) Medicare is 99.99 % always secondary because it is a government program (much like Medicaid.) I hope this helps:) Evan



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