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My family is currently covered by Blue Cross PPO through my husband's work. This is our only health insurance right now. However, premiums are going up for both us and the portion that the company pays, AND more of our providers are dropping Blue Cross. So essentially, we are paying more for less coverage.
I have two options for a second health insurance program: one would be an out-of-state provier through a company I do some work for; the other would be coverage through a professional society and may be a different carrier completely, like Kaiser or Health Net.
Does it help to have a second insurance provider? Or would we be constantly chasing two companies to get them to pay anything at all? How would we determine which carrier is primary and which is secondary for our kids? What is the best way through this maze? Trying to Keep Healthy
Coordinating insurance is a big pain in the butt. The primary will usually pay without much hassle provided you get the doctor's office clear on the procedure. It's the secondary that's the problem. Your service provider needs to send the Explanation of Benefits (EOB) describing the primary carrrier's action to the secondary along with the claim to the secondary to get them to do anything. Getting the service provider to do this correctly depends on the office claims processor's laziness and intelligence levels. Labs (such as Quest) will try to bill you directly over and over and will generally belligerently and rudely refuse to bill the secondary at all leaving you to the task of collecting from them yourself. This is, of course, difficult for you to do because you don't have the special claim codes that all the procedures would be billed under and the secondary will generally be very slow to respond without periodic harrassment from you over the phone. In theory, the secondary will review the claim and cover whatever portion they would normally cover once the primary adjustments have been applied.
However, once you meet the deductible of the primary, they have to pay everything for in-network services and then you're mostly home free and the secondary would only need to be involved when the services are out of the primary's network. So it could be worth being double covered anyway depending on how stable your jobs are, what the deductibles are, and what the costs per month would be.
My personal experience is that I do spend some time working with the service providers to bill correctly, and the secondary to pay. My primary is UnitedHealthCare ($2000 deductible! Argh!) and secondary is Blue Shield PPO -Double Covered
Does anyone out there have dual coverage with healthnet and Kaiser. I have Kaiser as my primary insurance, and Healthnet as my secondary insurance (by HMO birthday rule). I just called a practice that will accept Healthnet, but won't accept me if I am dual covered with Kaiser, b/c they say that Healthnet gives them a hard time with payments. They want me to pay out of pocket and get reimbursed. I called both Kaiser and Healthnet, and the insurances both reassured me that there should be no problem getting my bills reimbursed by Healthnet, if I see a Healthnet plan physician, but I'm concerned. Has anyone had experience with this dual coverage situation? Good or bad? Anon
1. If your secondary coverage is with an HMO or EPO or some other types of restrictive plans like that, they may not pick up the balance after the primary ins pays unless the service was rendered using a provider that is also in the 2nd ins's network. You may also need to follow all the rules of your 2nd ins. This is often impossible: if your prime ins is, say Health Net and your 2nd is Kaiser, well Ksr will not cover *any* non-emergency care at a non-Kaiser facility.
2. The second ins may not pay if the prime ins paid an amount equal to or greater than the 2nd ins *would* have paid had it been prime. (Confusing?). If the normal benefit for prime ins is 90% and the normal benefit for 2nd ins is 80%, 2nd ins may not pay anything since the prime paid more than its (i.e., the 2nd ins's) normal benefit.
3. Similarly, using the above %-ages, if the prime paid 90%, the 2nd may only pay 80% of the balance due after the prime pays.
4. There are other issues, such as pharmacy formularies, etc., you may need to investigate. My advice: read the contracts carefully *before* you rack up bills that you expect the 2nd ins to pay. Good luck! michael s.
We decided we were very glad to have it quite recently, when it looked like we were going to have to go to a UCSF biliatory duct surgeon for care, and he wasn't covered by the HMO.
If it's a choice between two HMO's I don't think I'd bother, I'd figure out which one works best for you and choose that. If it's between two PPO's and you have a percentage you pay, coordinated care will benefit you in that you will pay less for both. We've run into this with dental insurance...A root canal was paid at 50% by both insurance companies, thus 100% for us. Myriam
Whether this is worth it to you depends on how much it costs you, what is covered and to what extent (and whether your doctors accept both policies), and how much care you expect to need in the coming year. Has it been a while since you've been to the dentist? Are you planning a pregnancy? Does anyone in the family have a chronic condition requiring regular or recurring care (asthma, diabetes, depression)? Try to estimate the amount you'd end up paying out of pocket in a year, and compare that amount to the premium you'd pay for the second policy. If it's more, you come out ahead with the additional coverage, of course, and even if it's about the same, the second policy is a good idea because (1) the premium contribution is pretax dollars, and (2) it'll cover the unexpected -- you won't be facing that $1500 maximum deductible in the event of an emergency hospital admission.
It's not that likely that your new employer would agree to put the money they would have spent on your health insurance toward some other benefit, although you can certainly try. You've got a better chance if it's a small company or there is already some form of ''cafeteria'' benefit plan in place. (Congratulations on the new job!) Holly
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