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Dual Insurance Coverage: What You Need to Know

The Basics of Dual Coverage: Primary & Secondary Insurance Lowdown

Some patients have more than one insurance policy. Which one is billed first? And what happens if you get it wrong? Here are the basics.

Coordination of Benefits. When a patient has multiple insurance policies, they don’t get to pick which one pays first. The primary is determined by a set of guidelines called Coordination Of Benefits (COB). Secondary plans may cover excluded services and/or exhausted benefits on the primary plan.

Deductibles. What if both policies have a deductible? Patient is responsible for both, as applies. Checking patient benefits accurately for ALL policies is crucial for this reason.

How to File.
The primary insurer may accept e-claims, but secondary claims should be sent via mail or fax, along with the explanation of benefits from the primary and any other relevant documentation. Be sure to get correct mailing addresses & fax numbers when checking patient benefits to avoid delays.

Refunding the carrier.
Imagine receiving a letter from Cigna. It says they’ve overpaid you $40K, and now you have to pay them back. This actually happens! Avoid this terrible fate: check patient benefits yearly and remind them to keep their COB current.