Medical Insurance

Will secondary insurance cover claims denied by your primary insurance?


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2005-08-06 13:58:21
2005-08-06 13:58:21

As 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.

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Yes, subject to the limits in their policy. 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 received 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. Policy holders are not responsible for claims that deny for timely filing.

Relying on insurance can become a problem as various insurers may not pay claims. Time spent challenging denied claims also becomes costly for individuals as well as companies.

No. The primary insured MUST match who owns the vehicle, otherwise any claims made for that vehicle will most likely be denied.

Some people opt for discount car insurance and they get discount insurance coverage, claims can take a while to process and sometimes denied more frequently

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 Medicare 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).

all depends on the blue cross plan you have. A lot I come by through my job as an insurance biller the secondary will pick up any copays that medicare wouldn't cover. But there is some plans that won't pay if medicare doesn't pay. So, really, yea, your secondary should pick up some cost. Unless it is just co-pays, they have the choice to make that your responsibility as a member. Do take the time to figure it out, a lot of times if you don't fight your own claims, you pay much more than you need to. Always keep and look at your explanation of benefits that you should receive from the insurances after each visit explaining what they paid and what they denied and what you owe. Anything that is not listed in the "Allowable Amount" column, you are not responsible for. Especially if the place you attended is participating with that insurance. A lot of companies try to collect for money that was denied by the insurance, but they(the insurance) states you are not responsible for.

A payer of last resort is an entity that pays after any other primary programs have been billed. For instance, after a primary insurance company, a secondary or even tertiary program can come in and pay the last of a bill. In some cases, the patient can no longer be billed for services after this payer has paid or denied payment.

can a person be denied medical servises due to no insurance

Many insurance companies will denial claims for pre-existing conditions. You have a right to appeal all claims. You should call your company first to see why the clam was denied.

A Medicare attorney is the best choice for general Medicare claims. If you specifically have a claim that has been denied, there are even lawyers who specialize in denied claim cases, frequently referred to as denied claims attorneys.

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 paid 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.

An insurance denial attorney will fight for you, should your claim be denied by your insurance carrier.

While I don't have the numbers for you, for the most part the money Cigna uses to pay claims is not from their revenue at all. Most employers maintain a bank account of their funds which Cigna uses to pay claims. This is referred to as A.S.O. (administrative services only) funding. Cigna's pocketbook is not impacted by the claims paid or denied for these accounts, which make up the vast majority of their claim volume. In fact, paying a claim is less costly than denying a claim, as no one calls the insurance company regarding the claims that have been paid, just the ones denied. So the more claims denied, the more customer service agents Cigna must pay for. The financial incentive is actually to pay claims rather than to deny.

Go to court! If insurance is involved, let the insurance handle it and the insurance adjusters handling the case can make determination of injury based on speed and point of impact on a vehicle. If either insurance company denied them payment for injury, and they decide to sue you instead, they will have to back up their medical claims in a court of law. This typically includes things like: medical reports, x-ray results, CAT scan results, blood tests, etc.

This court hears cases in which individuals claim that the Department of Veterans Affairs has denied or otherwise mishandled valid claims for veterans' benefits.

That's funny,, No.... If you have been denied a claim, then no settlement is forthcoming. It's been denied. Please see Websters Dictionary , look up "Denied"

Yes, a photographer is required to carry professional liability insurance. A photographer will be denied shooting if they cannot prove that they have insurance.

Logically, he should not be denied his right of life insurance,even after his act of attempted suicide.But if there was police case,it's better to reveal the fact in the proposal form for consideration of the Insurance Company.

Yes, he or she should. And further, you should receive an official letter of declination directly from the insurance carrier.

First you need to be certain of who is legally liable for the damage. Insurance companies seldom refuse to pay damages unless the claim is unsubstantiated. If you have undisputable proof the other driver was at fault, then you can sue that person. -Additional - In most jurisdictions you have to sue the driver/owner and not the insurance company directly. The small claims court clerk can tell you for sure. The insurance company will defend the other driver/owner and pay the claim if you win in court.

Yes, You can bill the patient. All the bills are the responsibility of the patient anyway. The patient can contact their insurer if they think it should have been covered.

Claims are more typically denied rather than rejected. If the claim did not fit within the terms of the policy then you might get "reject" somewhere in the response, a more specific question would probably generate a better answer.

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