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Daycare Insurance>COB - Is Anyone Here A Medical Insurance Pro??
Max 01:29 PM 01-12-2017
I'm trying to understand how CoB with 2 insurance plans work since I'm having a baby soon and have the chance to purchase a second (expensive) insurance plan.
Primary Insurance: $750 deductible, 80% coinsurance, $6,000/person out-of-pocket Max
Secondary Insurance: $500 deductible, 80% coinsurance, $2,000/person out-of-pocket Max
Here's how I understand it (for hospital bills in my name only, not preventative care that's 100% covered):
1. Medical bill is sent to primary insurance.
2. Primary insurance pays nothing and sends bill to me until deductible is met ($750).
3. We pay $750 out of pocket.
4. Primary then pays 80% of all remaining bills.
5. The remaining 20% is billed to secondary insurance.
6. Secondary pays the remaining 20% of the bill and stores the difference as credit for any other expenses during the plan year.
*Both insurance plans look at the bill as if they were the only insurance plan and charge/pay accordingly. However, no bill can be covered above 100%.
Example: A $9,000 bill in my name
1. Primary bills me for $750 and I pay it.
2. The $750 applies to both insurance plan deductibles and so, both annual deductibles have been reached.
3. Primary pays 80% of the remaining $8,250, which is $6,600.
4. The remaining balance of $1,650 is sent to secondary.
5. Secondary pays $1,650.
Secondary looks at the $9,000 bill as if they were the only insurance plan. Secondary would have charged $500 to me for the deductible, then paid 80% of $8,500 ($6,800). Since paying 80% would go over the total amount, secondary pays the difference remaining ($1,650) and stores the remainder as credit ($6,800 - $1,650 = $5,150).
I will have paid $750, Primary paid $6600, and Secondary paid $1650.
Googling this has been a PITA
Obviously this example is simple and not the best, but if anyone could tell me if I'm on the right track or not I would really appreciate it!!!
Primary Insurance: $750 deductible, 80% coinsurance, $6,000/person out-of-pocket Max
Secondary Insurance: $500 deductible, 80% coinsurance, $2,000/person out-of-pocket Max
Here's how I understand it (for hospital bills in my name only, not preventative care that's 100% covered):
1. Medical bill is sent to primary insurance.
2. Primary insurance pays nothing and sends bill to me until deductible is met ($750).
3. We pay $750 out of pocket.
4. Primary then pays 80% of all remaining bills.
5. The remaining 20% is billed to secondary insurance.
6. Secondary pays the remaining 20% of the bill and stores the difference as credit for any other expenses during the plan year.
*Both insurance plans look at the bill as if they were the only insurance plan and charge/pay accordingly. However, no bill can be covered above 100%.
Example: A $9,000 bill in my name
1. Primary bills me for $750 and I pay it.
2. The $750 applies to both insurance plan deductibles and so, both annual deductibles have been reached.
3. Primary pays 80% of the remaining $8,250, which is $6,600.
4. The remaining balance of $1,650 is sent to secondary.
5. Secondary pays $1,650.
Secondary looks at the $9,000 bill as if they were the only insurance plan. Secondary would have charged $500 to me for the deductible, then paid 80% of $8,500 ($6,800). Since paying 80% would go over the total amount, secondary pays the difference remaining ($1,650) and stores the remainder as credit ($6,800 - $1,650 = $5,150).
I will have paid $750, Primary paid $6600, and Secondary paid $1650.
Googling this has been a PITA
Obviously this example is simple and not the best, but if anyone could tell me if I'm on the right track or not I would really appreciate it!!!