Which insurance should be primary???

[3junebugs]

What is the name of your state (only U.S. law)? MD and PA

I am at my wits end and hopefully someone can help me out.

My 10yo son lives with me and my husband. Our family is covered under Aetna. His biological father was ordered by the courts in Pa where he lives to provide health insurance for our son. He didn't comply for some years so my husband carried my son on his plan since we got married in 2003.

Finally in 2008 bio dad provided me with a medical card. Ever since then I have both insurance companies telling me that the other insurance is primary. about twice a year I have to call and fight for either insurance to pay on the claims. Aetna says that by default bio-dad is primary. Cigna says you have to go by the birthday rule. Step dad is in February and bio dad is in august. Sooooooo this means aetna is to be primary. So I call aetna back and say the birthday rule only applies if me as his mother was the subscriber to the insurance.

Who is right? Right now I owe over $1300 to his mental health provider and they are threatening to stop allowing him to come for treatment which he really needs if this doesn't get straightened out by out next appointment in two weeks. It's crazy that he has double coverage and neither want to pay.

 

[cbg]

This is not a matter that is determined by law. This is determined by the Coordination of Benefits clauses in the policies themselves.

Only someone who has read both policies can say.

 

[ecmst12]

Everything I have been taught said that a natural parent's insurance is primary over a step parent's insurance. Get a copy of the full plan document from Cigna and see what it says about coordination of benefits.

 

[3junebugs]

Everything I have been taught said that a natural parent's insurance is primary over a step parent's insurance. Get a copy of the full plan document from Cigna and see what it says about coordination of benefits.

unfortunately cigna won't send me anything because I am not the address on record. His father is not very "concerned" to say the least so my requests for help on this he just ignores. The bills aren't coming to him so he doesn't care.

Is there anything else I can do to find out that information? Also, are you saying that if both insurances have different guidelines I could just keep getting turned in circles???

 

[cbg]

Yes, if the two insurances have different rules you could keep going around in circles.

If the parent is not concerned, there is very little you can do.

 

[3junebugs]

Yes, if the two insurances have different rules you could keep going around in circles.

If the parent is not concerned, there is very little you can do.

So were paying for insurance that we can't use? I guess I'd rather tell his dad to drop our son at this rate. I'll update after I call the ins co this morning

 

[cbg]

It is not always cost effective to carry two insurances. Even if you were able to square away which was primary, there is no guarantee that both policies would pay on each claim.

FYI, if the policy is through employment, he will not be able to drop it until the next open enrollment period. That is Federal law.

 

[momm2500]

in most (not all) health insurance policies, if there is a court order-that will over rule anything as for determination of who is primary and who would be secondary. i am reading that bio dad is ordered by the court to provide health insurance for your son. that insurance policy would be primary, then natural mom or step dad would be secondary. (this does not apply to the state of california) birthday rule does not apply in this situation at all. so they are wrong in telling you this.

 

[CourtClerk]

Will everyone PLEASE stop calling him bio dad? He's not bio dad, he's the only FATHER this child has. He's DAD, not bio dad.

/soapbox

I guess I'd rather tell his dad to drop our son at this rate.

You cannot give his father permission to violate a court order.

 

[TinkerBelleLuvr]

I had similar issues dealing between dad's insurance and mine. I ended the problem by having it stipulated in court as to which was was primary and which secondary. We looked at both insurance plans and evaluated them.

 

[ecmst12]

Um....insurance policies are not changed because of a court order. Primary/secondary is determined by the rules of the plan. The EASIEST way to solve a problem like this is to drop one of the plans.....most of the time the court is not going to order both parents to carry coverage.

 

[JustAPal00]

Um....insurance policies are not changed because of a court order. Primary/secondary is determined by the rules of the plan. The EASIEST way to solve a problem like this is to drop one of the plans.....most of the time the court is not going to order both parents to carry coverage.

So OP, Have your husband drop the coverage on your son at the next open enrollment, then the "SPERM DONOR's" insurance will be the only one on him!

 

[cbg]

Will everyone PLEASE stop calling him bio dad? He's not bio dad, he's the only FATHER this child has. He's DAD, not bio dad.

That may be so, but it makes a difference when it comes to insurance policies.

 

[momm2500]

here is some standard wording that is in MOST (not all insurance policies), so you will need to read the coordination of benefits section of each policy. also, if you have a copy of the court order, send a copy to both insurance companies!!!!!

D. In the case of a dependent child whose parents are divorced or separated:
1. If there is a court decree which states that the parents shall share joint custody of a dependent
child, without stating that one of the parents is responsible for the health care expenses of the
child, the order of benefit determination rules specified in (C) above will apply.
2. If there is a court decree which makes one parent financially responsible for the medical, dental or
other health care expenses of such child, the benefits of a plan which covers the child as a
dependent of such parent will be determined before the benefits of any other plan which covers the
child as a dependent child.
3. If there is not such a court decree:
If the parent with custody of the child has not remarried, the benefits of a plan which covers the
child as a dependent of the parent with custody of the child will be determined before the benefits
of a plan which covers the child as a dependent of the parent without custody.
If the parent with custody of the child has remarried, the benefits of a plan which covers the child
as a dependent of the parent with custody shall be determined before the benefits of a plan which
covers that child as a dependent of the stepparent. The benefits of a plan which covers that child
as a dependent of the stepparent will be determined before the benefits of a plan which covers that
child as a dependent of the parent without custody

 

[momm2500]

Will everyone PLEASE stop calling him bio dad? He's not bio dad, he's the only FATHER this child has. He's DAD, not bio dad.



we are all just indicating what the original poster indicated in their message**************..bio-dad! or natural dad