How to Coordinate Primary & Secondary Health Insurance

Within the majority of households in America, there are two working adults, or one or more adults who are working two jobs. This can create confusion when insurance benefits are provided by more than one employer. Understanding how to coordinate benefits and properly file your health insurance claims can help you to avoid having to re-file, or worse, your claim being denied.

Things You'll Need

• Copy of Coordination of Benefits policies from each insurance provider
• Insurance cards and numbers for each insurance policy
• Telephone
• Medical bills and explanation of benefits from your insurance providers

Instructions

1. Find out which insurance company is your primary provider. In most cases, the insurance that is provided as a benefit of your primary job is your primary insurance provider. For example, if you work and get insurance through your employer, but are listed as a dependent on your spouse's insurance, your employer's insurance should be filed as primary. If you have two jobs, it will most likely be the job that you consider your main occupation.

2. Understand what Coordination of Benefits means. Ask both of your insurance companies for a copy of their policies regarding COB (Coordination of Benefits). These policies dictate how the companies agree to cover expenses for individuals who carry more than one type of health insurance. The goal of COB is to provide coverage for medical bills, while ensuring that neither provider overpays over the cost of the expenses.

3. Let your medical providers know which insurance is primary and which is secondary, since they must file them in this order. If your doctor's office sends the bill to your secondary insurance carrier without first filing it with the primary, it will be denied. The secondary insurer will refuse to pay until the primary provider has picked up their portion (the larger part) of the bill. In general, secondary insurance will pay the rest of your expenses and, in all likelihood, you will not be responsible for more than a small co-payment or deductible.

4. Save all of your documentation. If you have problems with either provider denying a claim, be certain to keep the documentation so that you can file an appeal or pursue other action if necessary. This means keeping a file of your Explanation of Benefit statements, as well as any correspondence with either insurance company or your medical providers.

5. Fill out your Coordination of Benefits update regularly. Your insurance companies will generally ask you to update your COB a few times a year, indicating any other insurance and providing details of that coverage. Do not neglect to send this information in as soon as you get the request for it, since failure to do so can result in denial of claims.

Tips & Warnings

• If your insurance situation changes and you lose coverage, notify the other insurance company immediately; if you do not notify them, you risk having your claims denied for a period of time. This is particularly true if you have lost your primary insurance; be prepared to produce documentation showing the date of termination of coverage from your other policy.

Resources

• Read this Article in Spanish
• All About Coordination of Benefits