Updating Insurance Details: A Guide To Changing Primary Insurance In Therabill

Therabill is a platform that allows users to submit insurance claims. It is used by both patients and healthcare providers. The platform supports both primary and secondary insurance claims. In the case that a claim has a remaining balance after the primary insurance has paid, the user can submit the claim to the secondary insurance. This can be done either electronically or by print and mail.

Removing the previous primary insurance plan

To remove the previous primary insurance plan, the first step is to ensure that the plan has been removed or that the coverage has ended. It is important to note that if there are any claims attached to the primary insurance plan, the plan cannot be removed, and only the coverage can be ended.

Once the previous primary insurance plan has been removed or the coverage has been ended, the next step is to remove or end the coverage for the secondary insurance plan. If you are ending the coverage, ensure that the coverage end date matches the coverage end date on the primary insurance plan that is being replaced. Similar to the primary insurance plan, if there are any claims attached to the secondary insurance plan, only the coverage can be ended, and the plan itself cannot be removed.

Additionally, when ending coverage for an insurance plan, the coverage end date must be on or after the date of any claims or pre-authorizations associated with that plan.

Ending coverage for the secondary insurance plan

Ending coverage for a secondary insurance plan in Therabill involves several steps. Firstly, ensure that the previous primary insurance plan has been removed or that its coverage has ended. Note that if there are claims attached to the primary insurance plan, it cannot be removed, and the coverage must be ended. Similarly, if there are claims attached to the secondary insurance plan, it cannot be removed, and its coverage must be ended.

Next, remove or end the coverage for the secondary insurance plan. When ending coverage, ensure that the coverage end date is the same as the coverage end date on the primary insurance plan being replaced. After that, click on "Add Plan" and add the patient's new primary insurance plan, making sure that the coverage start date is the day following the date that coverage was ended on the previous primary plan. It is important to remember that when ending coverage for an insurance plan, the coverage end date cannot be earlier than the date of any claims or pre-authorizations attached to that plan.

By following these steps, you can effectively switch the secondary insurance plan to be the primary insurance plan for the patient in Therabill.

Adding the new primary insurance plan

To add a new primary insurance plan, you must first ensure that the previous primary insurance plan has been removed or that its coverage has ended. If there are claims attached to the primary insurance plan, the coverage can only be ended, not removed.

Next, remove or end the coverage for the secondary insurance plan. Again, if there are claims attached to the secondary insurance plan, the coverage can only be ended, not removed. Make sure that the coverage end date is the same as the coverage end date on the primary insurance plan that is being replaced.

Now, you can add the patient's new primary insurance plan. Ensure that the coverage start date is the day following the date that coverage was ended on the primary plan. When ending coverage for an insurance plan, the coverage end date may not be earlier than the date of any claims or pre-authorizations attached to that insurance plan.

Once the new primary insurance plan has been added, you can submit a claim to the primary insurance payer and await payment. When that is paid, you can submit a claim to the secondary insurance payer.

Understanding the difference between primary and secondary insurance

It is not uncommon for individuals to have more than one health insurance plan. This can occur when spouses both have employer-sponsored health insurance plans, or when an individual has personal health insurance and employer-sponsored coverage, or when an individual has two employer-sponsored health plans and Medicaid.

The primary insurance is the first policy responsible for covering medical costs. It is typically the main source of coverage for an individual or family and is billed first. For example, health insurance received through an employer is usually primary insurance. The secondary insurance comes into play when the primary insurance plan is exhausted and may help cover additional health care costs. It is important to note that the order of payment and the extent of coverage provided are the key differences between the two types of insurance.

When an individual has dual insurance, their circumstances determine which insurance is primary and which is secondary. For example, if a wife has a health plan with her employer, but her husband's health plan also covers her, the wife's employer is the primary insurer, and the husband's health plan is secondary. In the case of a child under 26, the Affordable Care Act lets children stay on their parents' health plan until they turn 26. So, if a child has their own health plan through an employer while remaining on the family's plan, the child's health plan is primary, and the parents' plan is secondary.

When it comes to billing, primary and secondary claims are not submitted simultaneously. The claim is first submitted to the primary insurance payer, and once that is paid, a claim can be submitted to the secondary insurance payer. It is important to understand how your particular insurance plans work together to get the most coverage.

Submitting a claim to the secondary insurance payer

If there is a remaining balance after the primary insurance has paid its share, you will need to submit a claim to the secondary insurance payer. It is important to note that you cannot submit a claim to both insurance companies simultaneously. You must submit the claim to the primary insurance first, wait for their payment, and then submit the claim to the secondary insurance.

Before submitting a claim to the secondary insurance, confirm which insurance is the primary insurance and which is the secondary insurance. You can do this by checking the coordination of benefits (COB). The COB is a provision in an insurance policy that specifies what each insurer is responsible for paying. Usually, a patient's coverage from their employer will be the primary insurance, and their coverage from a spouse or parent will be the secondary insurance. If a patient has both Medicare and employer coverage, the employer-based insurance is the primary insurance as long as the company has 20 or more employees.

Once you have confirmed that the primary insurance has paid and you are ready to submit the claim to the secondary insurance, there are a few key details to include in your submission. In addition to the regular billing details, you will need to specify the total that was billed initially, the amount paid by the primary insurer, and the reason why the primary insurer did not pay the full balance. It is also recommended to include the full explanation of benefits from the primary insurer.

There are two main ways to submit a claim to the secondary insurance: directly to the payer or through a claims clearinghouse. Many payers, especially larger ones like Medicare, allow providers to submit claims directly. This option eliminates the need for additional services and allows you to deal directly with the insurer. However, you are solely responsible for catching any errors or omissions in your submission.

Alternatively, you can submit your claim through a claims clearinghouse. This option involves submitting your claim file to your clearinghouse account, where it will be reviewed and checked for errors before being forwarded to the payer. Using a claims clearinghouse can help catch errors and omissions before submitting the claim, reducing the likelihood of a denied claim and saving time on appeals.

When submitting a claim to the secondary insurance payer, it is important to follow the specific guidelines and requirements of the payer. Some secondary insurance payers may require a printed claim form, while others may accept electronic submissions. Ensure that you provide all the necessary information and supporting documentation to ensure a smooth and efficient claims process.

Frequently asked questions