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How To File A Claim When You Have More Than One Health Insurance Coverage

When Both Plans Require Filing A Claim Form

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The steps involved in filing the claims yourself are:

Step 1. Get a claim form for each insurance plan you have. NOTE: Medicare requires the physician to submit the bill directly to Medicare.

Step 2. Get a copy of the itemized bill your doctor would send to an insurance company. This is usually more informative than a bill that just lumps multiple items under one charge or type of charge. It must include:

  • Identifying information about the plan.
  • Details about you and your coverage.
  • An itemized listing for every procedure or test being billed.
  • The procedure code for each item.
  • A diagnosis code for each procedure.

Step 3. Determine which plan is primary and which is secondary using the guidelines in Coordination of Benefits..

Step 4. Complete the claim form for the primary insurance company and send it to the company with a copy of the itemized bill

  • Keep a copy of the itemized bill. The other carrier will also need a copy of the bill.
  • Don't try to hide the existence of the secondary carrier from the primary. When the claim form asks if there is other insurance, tell the truth and report it.

Step 5. Upon receipt of the Explanation of Benefits from the primary carrier, submit  to the secondary carrier the following:

  • The completed secondary claim form.
  • A copy of the itemized bill.
  • A copy of the primary carrier's Explanation of Benefits.

For information on how to track medical insurance claims see Keeping Track Of Your Claims For Medical Bills: A Simple Method.

Once you receive an Explanation of Benefit (EOB) from the secondary carrier, compare it with the primary carrier's EOB and the itemized bill:

  • Do the payments from the two companies total the entire bill? If so, then the plans have paid correctly.
  • If the total was not paid, look to see why:
    • Was there a charge denied completely by both carriers? Remember, if the Secondary plan doesn't cover something, but the Primary plan does, the Secondary plan will pay for it as well out of its savings.
    • Did the Secondary carrier pay as much as it would have if it had been the only carrier? While this won't happen often, remember neither carrier ever has to pay more than it would have if it had been the only carrier.
    • Did the Secondary carrier apply a deductible or coinsurance to the payment? It may consider those in determining its maximum payment, but actual payment should be simply the total covered bill less the Primary's payment.

If the two payments do not equal the total amount of the bill, and you don't see a reason why they don't, it is recommended that you follow the procedure described in Health Insurance: Claims and Health Insurance: Claims Appeals.

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