Double insurance

[tammy8]

What is the name of your state? NC

Okay I can say I know a bit about P & C insurance but health, I stay away from

Recently one of my stepchildren broke her ankle. Today we get an eob and seems we need to pay the deductible as this was different from office visits.

On a side note, I KNOW that bm's new husband also has coverage on my stepkids and that his birthday falls before DH's. Should I call and see if his insurance covered anything or what? Will our insurance company tell us anything?

It is not a matter of paying 1/2 deductilbe but I hate the thoughts that bm will not have to pay anything and give DH nothing on what benefits she receives.....

Point in case on the double coverage thing, steps had to have some dental work done monthes ago. I KNOW (from the mouth of sf) that he has coverage on the steps as well. One of the kids had to have spacers that cost DH over $1000 dollars. Supposely we are to get 1/2 that back and then reimburse bm for the money spent. I beleive that her new husband's insurance also covered (therefore in my mind, bm gets 1/2 back also). Without a court order how do we find out who is getting reimbursed???

Thanks for the advice.

 

[tammycon]

Tammy i'm not a lawyer but I do pay medical claims and I have for years and I can tell you that court order always comes first in divorce situations so if your husband covers the kids by court order he would be primary coverage no matter who's birthday is first.
I also can't believe that he is expected to pay money out of his pocket without receiving copies of everything. There is no way I would give half that money back knowing there is secondary coverage because 90% of the time that secondary coverage will pick up a portion if not all that is left on the bill. The same thing goes for that deductible bill , is that your company's deductible ? If it is, the secondary insurance may pay that portion if there is no deductible under the other insurance (* I HAVE A SIDE COMMENT ABOUT THIS ISSUE).He may be able to get a statement from the DR or dentist who is rendering the services after all he is the children's father. Your insurance wouldn't be able to help you out because they see the bill first and have no idea where it goes after that or who else pays money on it.

*As far as that deductible you owe on the broken ankle...If that claim is an emergency room bill did the company process it as an in network or out of network ? Most policies try to cover emergency room visits at in network benefits because as long as it's a true emergency they don't want you to have to worry about finding a contracted hospital they just want you to get to the closest place possible for treatment. So if they processed that bill as out of network you may want to call them and ask about that especially since you have no control over where BM takes the kids in an emergency.
I hope some of this info helps...

 

[cbg]

When there are two different insurance policies covering the same individual, 999 time out of 1000 this is how it works:

1.) The bill is sent to the primary carrier, who pays the amount due under their policy.

2.) The bill, with an Explanation of Benefits showing the payment of the primary carrier, is sent to the secondary carrier.

3.) The secondary carrier determines what would have been covered, if they had been the primary carrier.

4.) The amount paid by the primary carrier is subtracted from the amount the secondary carrier would have paid, if primary.

5.) Secondary carrier pays the difference, if any.

Thus there are three possible scenarios; the secondary carrier would have paid more, the secondary carrier would have paid less, the secondary carrier would have paid the same. Only in the first scenario would the secondary carrier have any responsibility to pay anything.

Examples: The bill is for $100 and the primary carrier pays $80.

Scenario one: The secondary carrier, if primary, would have paid $90. The secondary carrier now pays $10.

Scenario two: The secondary carrier, if primary, would have paid $50. The secondary carrier now pays nothing, since the primary carrier has already paid more than the secondary carrier's policy calls for.

Scenario three: The secondary carrier, if primary, would have paid $80. They now pay nothing, since the amount due under either policy has already been paid by the primary carrier.

I won't go into the details of how the primary and secondary carrier are determined. While it is true that in most cases the "birthday rule" holds, there are some other factors that can affect this, including the terms of a divorce decree. But unless the secondary carrier has significantly better coverage than the primary carrier, it is rarely worthwhile to carry two policies on the same person(s).

 

[tammy8]

Thanks for the quick replies.

The reason for double coverage is that my husband provides it per the divorce, but bm's new husband also has children and he added my stepchildren since it didn't cost more.

BTW the new husband is a dr himself and his office took the xrays. Then the child was sent to a specialist who did the orthopedic work.

Thanks again, as I know that bm would never give out the info on the secondary coverage...good thing her new husband and I are on good terms .