I'm pregnant and the financial advisor at my OB/GYN office had a meeting with us and told us it would not cost more than $1000 OOP for all of my appointments and the birth (if it even costs anything) because I'm covered by my parents' insurance and my domestic partner's insurance (same insurance company). My insurance sent me an estimate in the mail and it was over $8000 OOP IF everything goes well. I called my insurance company and asked them to explain why and they told me that since my parents' insurance is my primary I have to go through that for the birth and appointments and then my partner's might cover some of it (this is the same insurance company so they were looking at both policies). My parents' is a $5000 OOP max and my partner's is $1000.
Why is this? And why did they tell me I can't choose my domestic partner's as my primary?
Sorry, I don't know much about health insurance.
Question About Primary and Secondary Health Insurance…
byu/2014tumblrsurvivor inInsurance
Posted by 2014tumblrsurvivor
1 Comment
>And why did they tell me I can’t choose my domestic partner’s as my primary?
If people could “choose” what insurance is primary, billing would be an absolute mess across the industry. When you are a dependent on two policies, whichever was in force first will be your primary. There’s rarely a benefit to dual coverage except when one plan offers benefits the other doesn’t – like infertility services.
So here’s what happens – your primary insurance will process a claim, say it’s a $100 claim:
* Total charges: $100
* Allowed amount (the contracted rate with an in network provider): $80
* Deductible: $60
* Insurance paid: $20
The provider then turns around and bills your partner’s insurance secondary. This is where it gets tricky. Your secondary insurance will apply their benefit, but uses the contracted rate of your primary insurance as the secondary will not pay more than what your primary insurance allows. In this example, they will look at the $60 charge. Say your secondary insurance has a $35 copayment for this particular service:
* Primary allowed amount: $60
* Secondary benefit copayment: $35
* Secondary payment: $25
So, in all, the provider is getting paid $45 between the two insurance companies and you are responsible for the $35 leftover to reach the $80 allowed amount. Both insurances will track what you owe towards the out of pocket (I believe, it gets tricky calculating that).