What is the name of your state (only U.S. law)? MO
I recently had some dental work done and have dual coverage so I am expecting little to no out-of-pocket expenses. Well.... My primary coverage paid what I expected which was 50%. The balance was then submitted to my secondary coverage (AETNA) who basically took credit for my primary insurance coverage payment and made an additional VERY SMALL payment and advised the balance was mine to pay. Ultimately my bill from the Dentist was $891.00 of which my primary insurance coverage paid $532.22 advising my share was $358.78. The ORIGINAL charges were then submitted to the secondary carrier who reduced the charges from $891.00 to $793.00 because the Dentist was an In-network provider. My secondary carrier notes that THIS PLAN BENEFIT payable is $412.60. In the explanation of Coordination with Other Health Plan they advise: Reduced charges for in-network = $793.00, less $50.00 deductible which I paid = $743.00. THIS PLAN BENEFIT (before other health Plan) = $412.60. Other plan payment = $532.22. This plan payment (after other health plan) = $33.60. Patient responsibility = $227.18.
ISN'T THIS UNETHICAL FOR MY SECONDARY CARRIER TO BENEFIT FROM MY PRIMARY CARRIER'S PAYMENT? I am charged two separate premiums for these policies. I pay them both for coverage. It is not right for my secondary to benefit from my primary carriers payment!! I PAY THE PREMIUM, NOT THEM. I know that together they wold not want to pay more than 100% of the covered charges but for my secondary to do this is outrageous!!! And I would think unethical and illagal. Please let me know your thoughts.
I recently had some dental work done and have dual coverage so I am expecting little to no out-of-pocket expenses. Well.... My primary coverage paid what I expected which was 50%. The balance was then submitted to my secondary coverage (AETNA) who basically took credit for my primary insurance coverage payment and made an additional VERY SMALL payment and advised the balance was mine to pay. Ultimately my bill from the Dentist was $891.00 of which my primary insurance coverage paid $532.22 advising my share was $358.78. The ORIGINAL charges were then submitted to the secondary carrier who reduced the charges from $891.00 to $793.00 because the Dentist was an In-network provider. My secondary carrier notes that THIS PLAN BENEFIT payable is $412.60. In the explanation of Coordination with Other Health Plan they advise: Reduced charges for in-network = $793.00, less $50.00 deductible which I paid = $743.00. THIS PLAN BENEFIT (before other health Plan) = $412.60. Other plan payment = $532.22. This plan payment (after other health plan) = $33.60. Patient responsibility = $227.18.
ISN'T THIS UNETHICAL FOR MY SECONDARY CARRIER TO BENEFIT FROM MY PRIMARY CARRIER'S PAYMENT? I am charged two separate premiums for these policies. I pay them both for coverage. It is not right for my secondary to benefit from my primary carriers payment!! I PAY THE PREMIUM, NOT THEM. I know that together they wold not want to pay more than 100% of the covered charges but for my secondary to do this is outrageous!!! And I would think unethical and illagal. Please let me know your thoughts.