Secondary Insurance

[kcv]

What is the name of your state? Florida

Okay, I have another question. After six years of coverage, my insurance company out of the blue just denied coverage saying that I must submit all claims through my husband's policy first. My insurance company claims that when there is other insurance, it provides only secondary coverage. In order to receive benefits, I must now always submit a denial from my husband's insurance first. My insurance company claims this has always been their policy but has no explanation as to why it hasn't been enforced for the past six years.

The problem is that we live overseas and my husband's insurance only covers the country we live in. The health system here is a shambles and we frequently have to travel abroad for medical care. The fact is, anything we obtain in country, we DO submit to my husband's insurance company. Costs incurred in the U.S. or abroad we submit to mine.

Now here's my problem, my insurance company says it doesn't matter that my husband's policy explicitly excludes costs incurred outside the country. I must submit the claims to them anyway and obtain a denial. This seems ridiculous to me. Why should I create a paperwork nightmare for my husband's insurance carrier and possibly damage my relationship with them by constantly submitting illegitimate claims? Can my insurance company really force me to do this?What is the name of your state?

 

[moburkes]

When you read that big book that came with your insurance policy, what does it say about having coverage with another company?

 

[kcv]

My insurance certificate says the following:

"In the event that the Insured Person has other insurance under any group health plan which would, or would but for the existence of this insurance, be available or obligated to provide a benefit or to pay a claim, the Company will apply the coordination of benefits rule." (The coordination of benefits rule states that the insurance that covers the person as other than a dependent shall be considered first and that children will be considered first under the plan of the parent whose birthday falls earliest in the year.)

Since our policy would not be available or obligated to provide benefits or pay claims outside the country we live in, then I don't think we are obligated to submit claims outside this geographical area. Does anyone interpret this differently?

Also, since I am a dependent under my husband's policy, doesn't that mean my claims should go to my insurance company first? And my birthday falls before my husband's so shouldn't our children's claims also go to my company first?

 

[moburkes]

When you typed the coordination of benefits rule, did you type it exactly as it appears? If so, then it appears that your insurance should be first. Did you ask to speak to a supervisor at the insurance company to ask your questions?

By the way, you will not "damage" your relationship with your insurance company by submitting claims that will ultimately be rejected.

Also, ask for their requirement in writing that you must submit claims to your husband's carrier first.