Coordination of benefits

[choky27]

What is the name of your state (only U.S. law)? MI

Received form from Blue Cross Blue Shield asking me to respond on any secondary insurance in family. My questions are: 1. is there any benefit to me to do so if my wife's health insurance has inferior coverage than mine 2. Do I legally have to respond to this letter?

Basically, we are content with family coverage we have through my employer and do not wish to complicate our life with more paperwork.


Thx in advance

 

[cbg]

You do not legally have to respond to this letter in the sense that no one is going to drag you off to jail, or court, if you don't, but they legally do not have to pay your claim if you do not.

If they are the secondary carrier they have no legal obligation to pay the claim until your wife's insurer does, and it is fraud for you to deliberately withhold the information. If her coverage is so inferior then at her next Open Enrollment period, drop it and use yours only. Until that time, you're stuck with the situation as it is. I can promise you that until they get that letter back, BCBS is not going to pay one penny on your claim and there is no force in law that is going to require them to do so.

 

[commentator]

Don't you regularly get letters like this? You must not have had this insurance coverage very long, then.

They verify that you do or do not have coverage from other carriers every year. (This doesn't mean insurance that is available to you, it means insurance coverage you have signed up for and are receiving it.) They'll keep sending the letters if you don't reply. Eventually not responding would be interpreted as failing to cooperate, might affect your keeping your insurance that you do have.

What you reply, if you are not covered by your wife's insurance and don't want to be, is no, of course. If you are covered on your wife's insurance you'll answer yes. My husband and I both worked for years for places that each had different Blue Cross/Blue Shield carriers. I wasn't on his, he wasn't on mine. Every single year, we each received a letter in which we had to confirm that we were or were not carried by the insurance of our spouse.

 

[choky27]

You do not legally have to respond to this letter in the sense that no one is going to drag you off to jail, or court, if you don't, but they legally do not have to pay your claim if you do not.

If they are the secondary carrier they have no legal obligation to pay the claim until your wife's insurer does, and it is fraud for you to deliberately withhold the information. If her coverage is so inferior then at her next Open Enrollment period, drop it and use yours only. Until that time, you're stuck with the situation as it is. I can promise you that until they get that letter back, BCBS is not going to pay one penny on your claim and there is no force in law that is going to require them to do so.

Sorry, guess I was not clear enough. Blue cross is primary insurance for whole family through me, my wife only has insurance for herself through her company, covering only her, not rest of family. And yes, I changed employer 2 years ago, so this is first time I am receiving such form.

 

[cbg]

Then you need to send the letter back telling them that your wife has other coverage and the rest of the family does not. This is quite standard and BCBS has a legal right to this information.

 

[choky27]

Then you need to send the letter back telling them that your wife has other coverage and the rest of the family does not. This is quite standard and BCBS has a legal right to this information.

I hear you. My issue with that is that BCBS would probably ask my wife to first submit to her insurance first and than to mine as secondary, BUT I do not have option when subscribing to pay/carry only my children, without wife. It appears to me that BCBS is charging me for insuring whole family (which for me includes my wife as well) and then would force her to claim first with someone else. I could be wrong, just feel this is not fair...

Thx to all for contribution to my question.

 

[commentator]

OP they are not forcing you to do anything. You may as well cooperate with them, as if it ever comes up and you refuse to answer this request for information, you could totally lose your insurance coverage.

But yes, if she has another insurance coverage through her work that she or her employer is paying for, and is also being carried by you on your "family coverage" (because you cannot omit her and keep your children on family coverage) then her insurance is her primary insurance, and your insurance is her secondary carrier, and it ever comes up, the medical entities wanting payment would use her insurance as her primary, and then let your insurance, by which she is also covered, see if they can cover whatever the primary insurance does not cover. How on earth could you perceive this as not being fair to you?

 

[cbg]

I hear you. My issue with that is that BCBS would probably ask my wife to first submit to her insurance first and than to mine as secondary, BUT I do not have option when subscribing to pay/carry only my children, without wife. It appears to me that BCBS is charging me for insuring whole family (which for me includes my wife as well) and then would force her to claim first with someone else. I could be wrong, just feel this is not fair...

Thx to all for contribution to my question.

Yes, they would. That's because, LEGALLY, her insurance is supposed to pay first. LEGALLY, they have no responsibility to pay first if she has insurance through another source. As I said before, your option is to have your wife drop her coverage at the next opportunity and have only your coverage. But as long as she has insurance through her employer, IT PAYS FIRST and BCBS has every right to know that coverage exists.

FYI, I do not work for BCBS. I do not work for any insurance carrier - I work for a university. But I've spent enough time working with employee benefits to know how it works. You have no option here except to either respond truthfully to the letter, or accept that no claims will be paid until you do.

BTW, if this is employer sponsored coverage, it's not BCBS that made the decision that you have to have your wife on the policy in order to have your children - it was your employer who made that decision. And neither your employer nor BCBS made the decision for your wife to accept coverage through her employer that you did not intend to use.