COB - Is Anyone Here A Medical Insurance Pro??

[Max]

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!!!

[Michael]

I am going to put your thread under the insurance category. I believe DCI (Day Care Insurance) may get an email from your question.

[Daycare Insurance]

Have you spoken with a representative from each company? It's hard to say for sure, since each company operates differently and a lot can depend on your plan. Your bet bet would be to talk to someone at both companies and have them break it down for you. Generally, yes, the secondary insurance company will get billed for whatever the remaining balance is after your primary carrier pays. But again, speaking to the insurance companies directly will ensure that you have completely accurate information.

[Max]

Originally Posted by Daycare Insurance

Have you spoken with a representative from each company? It's hard to say for sure, since each company operates differently and a lot can depend on your plan. Your bet bet would be to talk to someone at both companies and have them break it down for you. Generally, yes, the secondary insurance company will get billed for whatever the remaining balance is after your primary carrier pays. But again, speaking to the insurance companies directly will ensure that you have completely accurate information.

Thank you for the reply!

I've called both insurance carriers and several departments at the medical facility itself, and no one can give me a clear breakdown of how this would be processed. I'm sending emails now but I don't have much hope for that (usually I get a reply saying to call to speak with a rep).

Unfortunately its only made for more questions as to how this would be processed

[MyAngels]

I'm sure this has all changed in the years since we had double insurance, but it used to be that the bill was submitted to primary first, then whatever wasn't paid by primary was submitted to the secondary insurance. The deductible had to be satisfied for both plans as well.