<p>Hey Parents - I hope one of you can shed some light on my situation, as my parents are immigrants and are confused just like me. </p>
<p>My mom has health insurance from her job. She pays for it, it covers our whole family, and everything is great. My dad didn’t sign up for his health insurance because our family of four was covered under mom’s plan. Then my dad did sign up for his insurance in hope of alleviating some of the out-of-pocket costs of brother’s new braces. We’ll see how that goes, but whatever. </p>
<p>The problem is, when we got our second insurance, I got a call from our first insurance asking if we have another insurance as well. I said we did, after which the operator told me that that my original insurance from my mom’s job is now considered secondary for me, my brother, and my dad.</p>
<p>Now I find out that one of my doctors can’t accept me anymore as my previously primary insurance became secondary. Now I have to switch doctors. </p>
<p>Is there anything at all wrong with the situation I just described? Is someone wrong somewhere? One would think that being covered under two insurance policies would broaden, not limit, my options. </p>
<p>My family, thankfully, has no serious health concerns, and I understand that many are less fortunate than we are.</p>
<p>Disclaimer…I am NOT an insurance expert…but this is my experience based on our insurance coverage. It may not be the same everywhere.</p>
<p>Your state should have very specific guidelines on primary insurance in the event that your family holds two policies. Since you are apparently covered under both plans, why not just drop your dad’s and then your mom’s will be your primary again. The reality is that BOTH insurance companies will NOT pay for out of pocket expenses. The second company will reduce it’s payment based on what the first one paid. In no event will they pay more than the “reasonable and customary charge” in total. We used to have dual coverage back in the day when it DID pay those extra charges. When that changed, we found it to be more of a hassle than anything else. PLUS both of our jobs required us to pay a portion of the coverage for the folks who were not employees. We were better off banking the money we were paying to cover the dependents under the second plan and using THAT for overages.</p>
<p>Thats definitely an interesting case - I second the recommendation to check the regulations in your state. Maybe ask the person in the doctor’s office who handles billing - they might be able to explain it.</p>
<p>I know for me, my personal insurance has to be considered as my primary and my parents insurance that still covers me is secondary. But for two insurance policies where you are not the primary holder on either is a different case. Couldn’t tell you why one would be considered primary over another.</p>
<p>The policy holder with the earlier birthdate (date in the year, not older) is primary for all family members except the other person who holds a policy. I am not in insurance either.</p>
<p>Dad, birthday Feb. 10, policy (his policy is primary for him only)
Mom, birthday Jan. 26, policy (her policy is primary for her and the kids)
four kids</p>
<p>I am in employee benefits and Yes, that is the case.</p>
<p>BUT, worth2try, if all you’re (or your parents) interested in is higher reimbursement for brother’s orthodontia, your dad should ONLY sign up for his company’s dental plan, not for the medical plan. Some companies require that you enroll in both if you want one. If that’s the case, I wouldn’t bother with either, since it’s causing problems for your medical coverage.</p>
<p>Someday this will all be simplified . . . .</p>
<p>Isn’t wonderful that two companies are receiving payment for insurance services, and one of the companies is almost making pure profit from your family and doing so with virtually no risk to themselves. Your family on the other hand receives the just insurance benefit that is beyond the first company’s deductible.</p>
<p>In general, it shouldn’t matter who’s insurance is primary. If your doctor is not part of your Dad’s plan, when they submit to his insurance, they will get paid $0 (or whatever they pay for out of network). Then the balance is submitted to Mom’s insurance, and they pay the difference up to what they normally would have paid. So the Doctor doesn’t get any less, unless …</p>
<p>You have some type of HMO/PPO with Dad’s plan, and the Doctor does not accept any more patients from Dad’s plan. In that instance, he may only get a fraction from Dad’s plan that he got from Mom’s plan. Since he is under a HMO/PPO contract, there is no balance to submit to Mom’s plan for the difference. Thus he doesn’t want you as a Dad’s plan patient because he won’t get enough to make it worth his while.</p>
<p>Another idea, which may not help with the braces, but might get cheaper desired care for all: Mom can enroll in one parent with children plan, and dad can enroll single coverage. The two policies could cost less than the one family plan with mom. </p>
<p>Also even if Dad has “full” family coverage, does he have to enroll you? Most enrollments ask for who you want to enroll. He can ask benefits dept if you can be excluded from his policy. Then Mom’s insurance is primary and only coverage.</p>
<p>the Birthday rule is a standard agreement amongst insurance companies, which does make is simple (or as simple as can be, particularly with divorces etc).</p>
<p>OP: OperaDad should be correct. If your dad’s coverage pays zero, your mom’s coverage should kick in.</p>
<p>yes, and that is what was the PITA for us. We finally dropped the second coverage. It was just a PITA to keep track of it all…easier to have the kids under the plan that paid the bills.</p>
<p>Our insurance works like that also, if Aetna doesn’t cover it than it falls onto Tri-Care. The problem you may face is that your deductibles will be different and so will the coverage, especially when it comes to vision, dentistry or pharamaceutical prescriptions. Luckily all of our providers know we have both, so sometimes I use Aetna, and sometimes I use tri-care. They always tell us which one gives us a better financial break.</p>
<p>As a retired military wife, I can tell you that I have had to have many doctors, so don’t be afraid to switch, especially as you have stated there is no medical concerns. How often do you go? Also, since the doctor informed you he cannot use your insurance, ask him to give you a recommendation of a doctor that does. He also might say, you can stay, it is just your co-pay will change since we won’t be using your primary insurance.</p>
<p>Thank you for all the responses! I did not understand the birthday rule, and thought that maybe the other insurance would make me secondary as well… oh my. </p>
<p>I don’t think I am brave enough to keep going to my doctor and hoping that the secondary insurance will pick up the tab. I am afraid I am unprepared to deal with the mess that may ensue and certainly do not want to shell out the cash in case it all falls through. </p>
<p>We realized that what my brother needs that is dental, not medical, insurance after the dentist pointed it out to my mom… </p>
<p>I think I will switch doctors and see how that goes. The reason I was hesitant is because I have a common problem that the common treatment course did not alleviate completely, and I was thinking of following up with the old doctor.</p>
<p>I think I will stay on both policies just in case. I am just a little ticked that my mom continues to pay for hers as before, but they changed the rules of the game.</p>
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