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Can the secondary insurance provider deny a claim that was not filed with the primary insurance provider first?
Wiki User
∙ 17y ago
Let me tell you what happend to me. I hope that this helps. I used to be covered by two insurance companies. My primary insurance company was through the company that I worked with. My secondary was with the company that my husband works with. When a claim was filed with my secondary insurance company they wanted to know how much my primary insurance company paid for and until then they would not pay anything. So I had to submit to my primary insurance company and once they paid some then the secondary would. I hope that this helped:) * Yes. A claim must always be made with the primary insurer first.
Wiki User
∙ 17y ago
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IF Patient primary insurance denied claim because provider is not contracted with them will secondary insurance pay on the claim?
yes
If the primary insurance allows more than the secondary insurance what would the secondary insurance pay?
Secondary insurance will not pay the claim but the remaining charges should not be billed to the member/patient. Provider of service should write off the patient responsibility that primary insurance applied.
If your primary insurance denies a claim for failure to have a referal will your secondary insurance pay the claim?
Read your policy
Is it required to make a primary dental insurance adjustment if the dentist is a preferred provider before submitting a claim to secondary insurance?
You wait until both claims are received then write off the lesser of the two amounts
Will secondary insurance cover claims denied by your primary insurance?
As long as it is a covered expense by your secondary insurance and a claim has been filed with the primarty insurance then the answer is yes. The secondary insurance will only cover the expense according to your plan.
What does the word payer mean in terms of health insurance?
The primary /secondary payer is usually the insurance plan covering the claim
Will secondary insurance pay claim if primary insurance is provided by the same insurance company?
yes, they will treat it as if the primary was a different company. You pay two premiums. If they do not, contact the DOI.
When should you submit a claim to a secondary insurance company?
After you have received the Explanation Of Benefits (EOB) from your primary carrier if there is coordination of benefits. If the secondary insurance is an indemnity you do not need to wait.
What if you are driving someone else's car and you get in an accident that is your fault?
Their insurance would be primary and your insurance would be considered secondary when filing a claim.
What happens when your primary insurance does not have a hospital in network but your secondary insurance does?
File a claim with both companies. The companies will pat what they are supposed to pay.
With Primary and Secondary Insurance your primary denied your claim because it was over a year is your secondary obligated to pay?
Yes, subject to the limits in their policy. No. With most insurance policies, there is what is called a timely filing limitation. For my company; contracted providers have 6 months, and non-contracted providers have 12 months to submit the claim. If your primary insurance received the claim within timely filing, you may have the option of submitting the claim to your secondary with proof that it was filed in a timely manner. If that doesn't work you can always appeal the decision with the secondary or for that matter the primary insurance company. Policy holders are not responsible for claims that deny for timely filing.
Does a medical provider have to take a secondary insurances' write off?
It depends. The first question to be answered is whether the medical provider has negotiated a contract with that insurance company. If not, then the secondary is responsible for 100% of the balance left by the primary--no adjustments allowed. The entire balance must be paid by either the insurance company, the patient, or any combination of the two. It's different if there is a contract in effect with the carrier. Nowadays, many insurance companies process those claims in any one of several ways. They can compute how much they would have allowed (the total of ins resp + pt resp) had they been primary. Having done that, they'll subtract the amount pd by the primary and pay the balance--if there is one. If the primary had paid more than the secondary would have allowed had they been primary, the secondary may not pay anything and the balance left would have to be adjusted off. Sometimes the secondary doesn't consider what the primary paid at all, and both companies will pay as primary..it can make a difference whether the other insurance that is listed as primary is an individual or a group policy; and the same for the secondary. Group plans trump individual plans. When they both pay as primary, and neither insurance has processed the claim incorrectly and the provider has now ended up with a legitimate credit balance on the claim, the provider has 3 choices at that time. They can refund the balance to the insurance plan that created the credit balance; they can send the overpayment amount to the patient; or they can keep the money and deposit into their account.
