Dual insurance coverage

[allfiredup]

I live in Georgia.

I'm leaving the company I currently work for on 3/9/06. The insurance at my new job isn't effective until 5/1/06. I intend to pay to keep my current insurance (COBRA) until the new policy is effective.

If I were to continue paying for my old coverage for a while after the new policy is in effect, is it possible to use them simultaneously? In particular, I'm thinking about the dental insurance. Could I use them both to avoid having to pay anything out of pocket?

I just don't want to do anything that could be illegal or even cause trouble with my new insurance. But it would be awfully nice to get a few crowns without having to pay 40% out of pocket!

Thanks.

[averad]

I bet your COBRA payments are going to be so high it wont be worth paying for both.

Yes you could hold both coverages at the same time. Your new policy would be primary over your cobra policy. You still could have a patient balance depending on your coverage.

[allfiredup]

Thanks for the input. I'm actually thinking about keeping only the dental portion thru COBRA, not the medical. It's only $37 per month. If I can use both simultaneously, it'd be worth paying for it for a few months.

[ecmst12]

You might want to check on whether it's legal to have cobra coverage when you have other active coverage....if it is the cobra coverage would be secondary over coverage from your active employment.

[cbg]

There is nothing illegal about keeping dental coverage on COBRA while picking up medical insurance from the new employer.

[ecmst12]

What about while picking up DENTAL coverage from an active employer?

[cbg]

Then it would depend. There are circumstances in which an employee is allowed to continue with COBRA even when other insurance is available. In most cases, it will relate to on-going treatment where either the provider is not available in the new coverage, or the procedure is not covered by the new coverage.

However, if the OP is under the impression that having dual coverage will guarantee that he will not have to pay anything out of pocket, he is in for a surprise EVEN IF one of those circumstances exists. That's not how it works.

What happens in the case of dual coverage is, the primary carrier (and the plans themselves will determine who is primary - the insured does not get to choose) will receive the bill and make payment.

The other insurer, the secondary insurer, will then look at the bill and determine how much they would have paid IF they were the primary insurer.

They will then pay the difference, if any.

Examples: For easy arithmetic, let's assume a bill of $100.

Example A. Primary carrier pays $80. Secondary carrier also would have paid $80 if they were primary. End result - secondary carrier pays nothing. Insured pays $20.

Example B. Primary carrier pays $90. Secondary carrier would have paid $80 if they were primary. End result - secondary carrier pays nothing. Insured pays $10

Example C. Primary carrier pays $80. Secondary carrier would have paid $90 if they were primary. End result - secondary carrier pays $10. Insured pays $10.

Example D. Primary carrier pays $80. Secondary carrier would have paid $100 if they were primary. End result - secondary carrier pays $20. Insured pays nothing.

So out of four possible scenarios, only one of them results in the insured having nothing out of pocket.

For the record, I have more than 25 years experience dealing with employer sponsored group plans, including 5 year working directly with a national insurance carrier, and have been working with COBRA ever since it was signed into law.

[ecmst12]

First - any insurance you get through an active employer is always going to be primary over everything, even Medicare (which you can have if you are over 65 even if you are still working).

Second - there is another possible scenario with dual coverage, though I don't remember the name of this type of plan.

With the same $100 bill, the primary insurance pays $80. The secondary insurance would have paid $80 (or some amount less then that but more then $20). They see that your other insurance paid $80 and $20 is remaining. Since $20 is still less then the $80 they would have paid had they been primary, they pay the $20. With this type of coverage, the only time the insured would have to pay out of pocket would be in a situation where the primary pays nothing or close to it (for example if a service is covered by one and not the other, or if the primary plan has a deductible and the secondary does not. For example the primary plan applies the whole $100 to the deductible, then the secondary would only pay $80.

I worked for health insurance for 7 years, in HMO, non-HMO, Medicaid, and Medicare supplement plans, both as customer service and claims processing Obviously not as long as you but in customer service sometimes you have to deal with the more day-to-day kinds of issues then the higher level people. The plan that I serviced when I worked for Aetna had the kind of plan I described for its enrolees with dual coverage, it allowed those people to not have to pay their copays out of pocket. It was the plan sponsor's decision to write the policy that way; I thought it was a nice benefit to the people carrying other coverage who were actually saving them money.

[cbg]

It's not true that employer sponsored insurance is always primary. With Medicare, it depends on the size of the employer. And in the poster's case, COBRA is also employer sponsored. They can't both be primary.

The type of coverage you describe where the insured would never have anything out of pocket is very, very rare. Instances where the secondary coverage automatically covers anything that the primary carrier didn't cover are few and very far between. It defies probability that either of the plans the poster has would be of this type, and the odds are doubled that his secondary plan would.

I did my years in customer service, kiddo. I started those 25 years as the receptionist for a benefits office. I wasn't born in management.

[ecmst12]

Cobra is not through an ACTIVE employer though. It's through a former employer.

[cbg]

That's true. And I'm not saying that the COBRA insurance wouldn't be secondary. I'm saying that your blanket, across the board statement that employer sponsored insurance is ALWAYS primary is incorrect.

[ecmst12]

Heh, well that's what they told me (and heavily emphasized) during my (rather extensive) training at Aetna, but I'll allow that they may have overly simplified the case. Is it safe to say that in the vast majority of cases, coverage through an active employer will be primary?

[cbg]

Leave out the vast and I'll go with it.

I have some experience with Aetna and I wouldn't take all their training points as gospel.

[kikijo11]

I live in Texas.

I have an insurance question that pertains to Dual Dental coverage. My primary insurance is "out-of-network" and my secondary insurance is "in-network". When billing the insurance companies, does the dentist have to honor the "in-network" negotiated rate from the Secondary insurance?

For example the billed charges were $100. Primary paid "out-of-network" fees of $50. Secondary insurance had a negotiated rate of $75 and paid $60 "in-network" fees resulting in an overpayment of the billed amount of $10. Does the dentist have to honor the secondary negotiate rate of $75 making the total over payment $35?

[ecmst12]

You should really start your own thread instead of hijacking someone else's.