dual insurance questions

[floofyboony]

VA

so i've been reading some past threads, but am not quite understanding dual insurance.

cbg, from past posts of yours i've read, you're saying it's rare for secondary insurance to pay much if anything on claims? so why even have secondary insurance? unless it's free of course.

i have the option of being doubly insured on my husbands policy for $70 a month. we plan on having another child in the next year. if the secondary insurance pays out more on this hospital birth than it costs to pay into it in the next year, it would be worth it for us. but, how do i find this out? call the hospital? call the provider? what questions do i even ask?

and then, ecmst12, you seem to tell a different story. basically that the secondary insurance will pay what they would if they were primary, minus anything the primary paid. well, this seems like there'd be little to no oop expenses...

so which one of you is right?

oh, and i'm not sure if it matters, but my h's policy and mine would be covered under the same provider, but would (obviously) be different policies.

[cbg]

We're both right. We're saying the same thing - just looking at it from different angles.

But unless the secondary policy would have paid more than the primary policy, they're not going to pay much if at all.

Example:

For easy arithmetic, let's say a bill is $100. The primary policy pays $80.

If the secondary policy, had they been primary, would have paid $80 or anything less than that, they will pay nothing at all. If, as primary, they would have paid $90, they will pay $10 - the $90 that they would have paid minus the $80 that was already paid. Only if they would have paid 100% of the bill, will you get the entire balance taken care of.

For most people, the cost of maintaining the secondary policy is greater than what the secondary policy will pay, unless the secondary policy has better benefits AND they have significant medical bills where both policies will get heavy use.

You will have to look at the policies themselves to see which policy has which benefits. You can get copies of the SPD (Summary Plan Description) from your respective employers.

[ecmst12]

It depends on how the particular policies are written and what the COB policies are.

[floofyboony]

cob?

... guess i have to lenthen this post.

[tranquility]

Each case is different, as is the specific insurance policy. No one can help you here in a specific sense. However, in a general sense, I had extraordinarily high medical bills and dual coverage on my wife and the secondary insurance caused more problems than it was worth. The payoff has been less than 1% of the premiums paid in, and there were hours spent writing letters when something was denied by both insurances because of a submission error by the provider. (Where the secondary was billed as the primary.)

Read the coordination of benefits clauses, but from my personal experience it is not worth the time, effort or cost.

[floofyboony]

what does cob stand for?

[tranquility]

Coordination of benefits.

[momm2500]

obtain a copy of the plan booklet/document for your husband's insurance plan and you can tell us what the coordination of benefits section indicates. one of us here would be able to tell you how the secondary will cover the charges.