Dual Coverage
Dual coverage is when patients have two insurance policies. It’s common for employed spouses and their children.
When two policies are in play, which one is billed first? And what happens if you get it wrong?
Coordination of Benefits
When a patient has multiple insurance policies, one is considered primary. The primary is determined by a set of guidelines called Coordination Of Benefits (COB).
Deductibles
If both policies have a deductible, the patient is responsible for both.
How to File
After filing a claim to the primary policy, you’ll receive an Explanation of Benefits (EOB) or Explanation of Payment (EOP).
The EOB/EOP is required to file a claim to the secondary insurer. Secondary plans may cover…
- the patient’s primary copay or coinsurance
- exhausted benefits on the primary plan
- services the primary insurer didn’t cover
The primary insurer may accept e-claims, but secondary claims should usually be sent via mail or fax. Note the claims mailing addresses and/or fax number during benefit verification.
Oops! I Filed to the Secondary First
There are two possible outcomes.
- The secondary insurer notices. They’ll reject the claim and ask you to send the primary EOB. No big deal.
- The secondary insurer pays. If this happens, the patient failed to update COB with the secondary insurer. Some frustrating clerical work will be required, and you’ll have to repay the carrier.