Georgia9764
Junior Member
I added my wife to my employers health insurance plan last spring after we were married. She has primary insurance through her employer. The insurance through my employer would be her secondary insurance.
It was my understanding that my wife would receive full benefit of my employers insurance less the amount her primary insurance covered, any remaining deductibles, etc. My insurance, or my wife's secondary insurance has better coverage.
Here is an example:
The billed amount from the doctor's office was $200.00. This was submitted to my wife's primary insurance. My wife's primary insurance, paid $57.00 of the billed $200.00. It is my understanding that under the my employers plan, because this doctor is in network, the secondary insurance would pay the agreed in-network charge for this service less the $57.00 the primary insurance has already paid, and any of the $300.00 deductible remaining. Our total out of pocket expense would be $2000.00 maximum for the calendar year under my employer's insurance plan, which is my wife's secondary insurance. The secondary insurance denying any payment beyond the $57.00 plan allowance under my wife's primary insurance. I am now being billed for the balance of the $200.00 bill or $143.00. The secondary insurance is paying nothing additional. The reason the secondary insurance is not paying anything additional is because the the Coordination of Benefits is set up as non-duplication of benefits. They use the other insurance allowed amount.
If this is truly the case, I am receiving no benefit form the secondary insurance I have been paying for. I was expecting to receive the full benefit of the secondary insurance less the amount the primary insurance already paid.
Thank you in advance for your help.
It was my understanding that my wife would receive full benefit of my employers insurance less the amount her primary insurance covered, any remaining deductibles, etc. My insurance, or my wife's secondary insurance has better coverage.
Here is an example:
The billed amount from the doctor's office was $200.00. This was submitted to my wife's primary insurance. My wife's primary insurance, paid $57.00 of the billed $200.00. It is my understanding that under the my employers plan, because this doctor is in network, the secondary insurance would pay the agreed in-network charge for this service less the $57.00 the primary insurance has already paid, and any of the $300.00 deductible remaining. Our total out of pocket expense would be $2000.00 maximum for the calendar year under my employer's insurance plan, which is my wife's secondary insurance. The secondary insurance denying any payment beyond the $57.00 plan allowance under my wife's primary insurance. I am now being billed for the balance of the $200.00 bill or $143.00. The secondary insurance is paying nothing additional. The reason the secondary insurance is not paying anything additional is because the the Coordination of Benefits is set up as non-duplication of benefits. They use the other insurance allowed amount.
If this is truly the case, I am receiving no benefit form the secondary insurance I have been paying for. I was expecting to receive the full benefit of the secondary insurance less the amount the primary insurance already paid.
Thank you in advance for your help.