Understanding Secondary Insurance: Submitting Your Bills Efficiently

If you have two health insurance plans, you may be wondering how to submit your bill to your secondary insurance. The process can be a little confusing, but it's important to understand how primary and secondary insurance works. Primary insurance is your main insurance plan, and it pays first for your medical expenses. Once your primary insurance has paid its share, the remaining bill goes to your secondary insurance, which covers some or all of the remaining costs. It's worth noting that having two insurance plans doesn't guarantee full coverage, and you may still have out-of-pocket expenses.

When submitting a claim to secondary insurance, you need to follow certain steps. First, you need to confirm which insurance is your primary coverage. Usually, your coverage from your employer is primary, while coverage from a spouse or parent is secondary. After confirming, you submit the claim to the primary insurance and wait for their response. Once the primary insurance has paid and you have received a remittance, you can then submit the claim to the secondary insurance. It's important to include details such as the total billed amount, how much the primary insurer paid, and why they didn't pay the full amount.

When to submit a claim to secondary insurance

If a patient has multiple insurance plans, it is important to first confirm which one is their primary coverage. Generally, a patient's coverage from their employer will be primary insurance, and their coverage from a spouse or parent will be secondary insurance. If a patient has both Medicare and employer coverage, the employer-based insurance pays first if the company has 20 or more employees. If it's a smaller business, Medicare pays first.

Once you have determined which insurance is primary, you can submit the claim to the primary insurer. After the primary insurer has paid their portion of the bill, if there is still a balance remaining, you can submit a claim to the secondary insurer. It is important to note that you cannot submit a claim to both insurers at the same time.

When submitting a claim to the secondary insurer, include the total amount billed initially, how much the primary insurer paid, and why the primary insurer didn't pay the full balance. Also include the explanation of benefits from the primary insurer. This will help to avoid a claim denial from the secondary insurer.

You can submit a claim to the secondary insurer electronically or through a claims clearinghouse. Submitting electronically means going directly to the payer, while a claims clearinghouse acts as an intermediary and can help catch errors before submitting the claim.

How to submit a claim to secondary insurance

Having two health insurance plans can help you cover insurance expenses, but it's important to understand how primary and secondary insurance works. If you have a patient with multiple insurance plans, here's how to submit a claim to their secondary insurance:

• Collect patient information: Gather up-to-date and accurate demographic information about the patient, including their name, birth date, and insurance plan subscription information.
• Check eligibility and verify insurance: Check eligibility and verify insurance for each of the insurance plans. If neither plan shows up as primary insurance, ask the patient to confirm the coordination of benefits (COB) or contact the insurers.
• Submit the claim to the primary insurance: Once you're ready to bill the patient's appointment or services, submit the claim to their primary insurance plan first.
• Note the primary insurance payment details: After the primary insurance processes the claim, make a note of the allowable amount, the patient's responsibility, and any adjustments.
• Submit the claim to the secondary insurance: Submit the claim to the patient's secondary insurance. Include the original claim amount, how much the primary insurance paid, and the reasons why the primary insurer didn't pay the full claim. Include the remittance information and explanation of benefits (EOB) to avoid a claim denial from the secondary insurance.
• Forward any remaining balance to the patient: Once the secondary insurance pays their portion of the claim, forward any remaining balance to the patient.

Understanding Primary and Secondary Insurance

It's important to understand the difference between primary and secondary insurance before submitting a claim to secondary insurance. Primary insurance is the insurance that pays first, up to coverage limits. You may owe cost-sharing on this plan. Secondary insurance kicks in once the primary insurance has paid its share. The remaining bill goes to the secondary insurance, if the patient has more than one health plan. The secondary insurance may cover part or all of the remaining cost.

When to Bill Secondary Insurance

You can submit a claim to secondary insurance once you've billed the primary insurance and received payment. It's important to remember that you can't bill both primary and secondary insurance at the same time.

Primary vs. secondary insurance

Overview

It is possible to have more than one insurance plan, and many people do. When you have two insurance plans, one is considered primary, and the other is secondary. The primary insurance is responsible for paying first, and the secondary insurance comes into play if the primary insurance cannot cover the entire claim.

Primary Insurance

The primary insurance policy is typically the main source of coverage for an individual or family. It is the first policy billed for medical expenses and is responsible for paying the majority of the costs. Primary insurance is often obtained through an individual's employer or purchased directly. It is billed first when you receive healthcare.

Secondary Insurance

Secondary insurance is a health insurance plan that covers you in addition to your primary insurance plan. It is billed when your primary insurance plan is exhausted and may help cover additional healthcare costs. Secondary insurance policies are often obtained through a spouse's employer or purchased separately.

When to Use Secondary Insurance

Secondary insurance comes into play when the primary insurance coverage is insufficient to cover all medical expenses. This can occur when the primary insurance has reached its coverage limits or has exclusions for certain treatments. In such cases, the secondary insurance can cover the remaining costs or fill in the gaps left by the primary insurance.

Coordination of Benefits

When you have primary and secondary insurance, they work together through a process called "coordination of benefits". This ensures that both plans pay their fair share without paying more than 100% of the medical costs. The coordination of benefits decides which plan pays first (primary) and which pays second (secondary).

Advantages and Disadvantages of Having Two Insurance Plans

Having two insurance plans can help cover medical expenses that would normally be out-of-pocket. However, it also means paying two premiums and potentially facing two deductibles. There may also be complications in the claims process when dealing with two insurance companies.

Scenarios where patients have secondary insurance

If you have multiple insurance policies, it's important to understand how to coordinate your benefits and properly submit your bills for reimbursement. In most cases, you should always submit your bills to your primary insurance first. Your primary insurance is typically your main health insurance plan, which may be through your employer, a private plan, or a government-sponsored program like Medicare. They act as the primary payer for your healthcare expenses. After your primary insurance has processed your claim and paid their portion, you will usually receive an Explanation of Benefits (EOB) outlining what was covered and what amount, if any, you are responsible for.

Once you know what charges your primary insurance didn't cover, you can then submit those remaining bills to your secondary insurance company. This could include any deductibles, copayments, or coinsurance amounts that you are responsible for under your primary insurance plan. Your secondary insurance acts as a supplement to your primary coverage and may help cover these additional costs. It's important to provide your secondary insurance company with the EOB from your primary insurer, as this document details the services provided, the approved amounts, and what you have already paid. This will help your secondary insurer understand what charges have already been processed and determine what additional benefits you may be entitled to receive.

For example, let's say you have health insurance through your employer (your primary insurance), but you also have a separate dental insurance plan (your secondary insurance). After visiting the dentist and receiving a filling, you would first submit the bill to your primary insurance company. Once they have processed the claim and paid their portion, you will receive an EOB. If there is a remaining balance that your primary insurance didn't cover, you can then submit the original bill and the EOB to your dental insurance company to see if they will cover any of the remaining costs.

Another scenario could involve Medicare and a Medicare Supplement (Medigap) plan. If you have Original Medicare (Parts A and B), this is typically your primary insurance. However, if you also have a Medigap plan, this acts as secondary insurance to help cover some of the out-of-pocket costs that Original Medicare doesn't cover, such as copayments, coinsurance, and deductibles. In this case, you would first allow Medicare to process your claims and pay their approved amount. Then, you can submit any remaining bills or costs to your Medigap plan for additional coverage. Remember, the specific coordination of benefits rules can vary depending on the insurance companies and plans involved, so it's always a good idea to review your insurance policies and contact your insurers directly if you have questions about how to properly submit your bills.

Coordination of benefits (COB)

The National Association of Insurance Commissioners (NAIC) created COB in conjunction with the insurance industry. It is not a law, but an industry standard. COB is especially useful when a person is covered by two health plans, as it is the process insurance companies use to decide which plan will pay first for covered medical services or prescription drugs and what the second plan will pay.

The primary plan is the predominant provider of benefits and must provide these as if the claim holder has no other insurance. The secondary plan then covers some of the remaining cost. The primary and secondary insurance will cover up to plan limits, and the policyholder may be responsible for any remaining amount.

The order in which the insurance policies are coordinated is dictated by insurance law and cannot be decided by a company or an individual. This process only takes place when multiple insurance plans are involved. If a policyholder has only one insurance plan, that plan is responsible for the entire claim.

COB is important because a lack of coordination between plans can result in the claim not being paid until the COB has been confirmed, causing financial difficulties. It also ensures that individuals who receive coverage from two or more plans will receive their complete benefit entitlement and prevents benefits from being duplicated when an individual has more than one policy.

When submitting a claim to secondary insurance, it is important to include the total that was billed initially, how much the primary insurer paid, and why the primary insurer didn't pay the full balance.

Frequently asked questions