When an individual has more than one insurance plan. You must determine which one of them is paid first, either Secondary one or Primary one. This is very important because it will help you to transmit the bill in the proper sequence, which results in the quick processing of payments, and the patients do not have any issues with their bills.
What Do You Mean By Primary and Secondary Insurance?
Primary Insurance:
- Primary insurance is the first plan. It firstly pays for the medical expenses. In this, the bills are checked by the insurance company to determine which facilities go through the plan and pay the payment straight to the doctor or to the hospital.
Secondary Insurance:
- Secondary insurance is the second plan that basically pays for the leftovers. After the secondary insurance, there are some things left to be paid for. These may include co-pays or deductibles.
For example, if a patient has $2,000 medical expense. The bill is checked by the insurance company. It will determine which services were included in the plan and decide to pay $1700 to the doctor. The remaining $300 is still not paid. Those $300 are then sent to the secondary insurance to pay for the leftover services.
Identifying Primary Insurance:
To determine which insurance plan should pay first if the patient has more than one insurance, the COB (Coordination of Benefits) rules are set up by the insurance companies.
- If the insurance is from the patient’s own work is primary it will pay first, and if the insurance is from the spouse’s work, it will be secondary and paid secondly.
For example, if Abid’s insurance is from his own job, and her wife is also involved with him. Abid’s plan is paid first, and his wife’s plan is paid after.
- In the second case, if the patient is a child, then both parents are involved in the insurance. Then the date of birth of both mother and father will decide who has to pay first.
For example, if the father’s birthday is on 15 August and the mother’s date of birth is 25 December, the father’s plan pays first.
- If the patient is a child and the parents are divorced. The court order will determine which party must pay first.
If there is no order from the court, the one who has the custody of the child will pay.
And if the custodial parent is remarried, then there are 3 other strategies:
- The insurance of the parent with the child custody will pay first.
- The step-parent’s insurance will pay secondly.
- The parent with no custody insurance will pay.
- If Medicare is involved and the pateint is still working and has the insurance through the job. The employee’s insurance plan will pay first, and Medicare will pay second.
If the employee is retired than then the Medicare plan is primary.
Confirming The Coordinates Of Benefits:
Even though it is confirmed which insurance will pay first, you must check again with the insurance company.
The following are some strategies for double-checking:
- Using the online portal.
- Billing clearinghouses.
- Call the insurance company directly and clarify which insurance has to pay first.
Usual Mistakes:
The following are the most common mistakes that cause issues:
- The first mistake is assuming that Medicare is always primary( will pay first). This is not right. Medicare always pays second. Like in a case we discussed, if Medicare is involved, if the employee is still working and has the insurance with that job. The employee plan pays first, and Medicare will pay second.
- The second mistake is billing the insurance in the wrong order.. Not confirming which insurance has to pay first can cause issues like delays in payments and additional work to correct the issue.
- Not focusing on the insurance date can also cause issues. So, it is essential to check whether the date on the insurance card is valid or not.
- Ignoring the new updates of Coordinated Benefits can also cause different issues.
Tools For COB Verification:
The following are some tools for COB verification, to check which insurance has to pay first:
- Medical Billing systems like Availity, Navinet, and Office Ally are helpful to show which plan is primary or which one is secondary.
- Another tool Insurance Company Website, to directly check the verification and get COB informations.
- Tools like Luma Health and Athenahealth will help with the update of the insurance they register.
Concluding Thoughts:
It is a very essential point to clearly check which insurance has to pay first. For this, you should take the following measures, which include checking the information of the pateint with accuracy, clearly checking and fully understanding the COB rules, and checking the sequence of insurance correctly. These will help to reduce the chances of any issues that may be caused and give you the correct results. Our expert at DocVaz medical billing helps for your services so you can work on patient care.
