Coordination of benefits - HRA and PPO

[automagrt]

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

I am covered by two different insurance plans from two different companies until the end of next month. The plan I will be losing is a PPO plan with office visit and prescription copays and 10% coinsurance. The other plan that I have is an HRA. Where I entered into it late, I was only allotted $583 of the normally $1000 yearly amount. I then have a $1500 bridge until everything is covered 100%. Thus far I have been putting my PPO plan as primary but am wondering if that makes the most sense. It looks like they are both being billed for the same thing and both paying out the contracted amount, so it's rapidly depleting my HRA. I thought just the copay would be deducted from the HRA. Would it be better to make my HRA primary? If I deplete the balance, will my PPO plan make up the difference and would that amount count towards the bridge? I'm trying to figure out what would be best for my situation since the HRA will be the only coverage I have after next month. I have some diagnostic imaging being done here in the next couple of weeks and may need an endoscopy done as well, so this will run through my HRA funds pretty quick.
Thanks!

 

[ecmst12]

YOU don't decide which plan is primary. Where are the plans coming from? Are they group plans or individual?

 

[automagrt]

They are group plans. The doctor's office, hospital, etc. always ask me which is primary, that's why I thought it was up to me. So who does decide? The insurance companies? I am just going to call them and ask about it as I had a question about some of the claims. I figured it would be an exercise in futility as they would both try to get me to make the other primary, but I guess it doesn't work that way. I've tried reading through the Coordination of Benefits section of one of my plan's booklets but it really doesn't tell me anything useful.

 

[ecmst12]

OK who are the group plans through? Your employer? Your spouse's employer?

 

[automagrt]

OK who are the group plans through? Your employer? Your spouse's employer?

They are both through my employers. I'm working for two different employers until the end of next month, at which point I will be losing the PPO plan when I go part-time. The deductible has already been met on that one, if that makes any difference.

 

[ecmst12]

If they are both plans through employers you are actively working for, then whichever one has been in effect longer should be primary.

 

[tranquility]

"Should be" is key. I did a lot of research on the COB issue and it is suprisingly difficult to find legal opinions on the matter. I did finally find an insurance industry set of guidelines (which I posted here probably a year or a year and a half ago), but that is hardly legal precedent.