You are here: Home Insurance Health Insurance ... How To File A ... When Both Plans Require ...
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

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

When Both Plans Require Only A Co-pay

Next » « Previous


If both of your carriers are HMO's and each only requires a co-pay:

  • Keep in mind that your treatment must come from a doctor who is part of the primary carrier's network in order to be treated for just the co-pay. The doctor must also be a part of the secondary carrier's network to get reimbursed by the Secondary carrier for the co-pay.
  • If you see the doctor regularly, you may want to accumulate several co-pays and request reimbursement for them every few months rather than one at a time.

To request reimbursement from the secondary carrier for the co-pays:

  • Ask your doctor to bill the non-co-pay carrier (the secondary carrier if both plans require co-pays and treatment is delivered by a doctor that is in both networks), or
  • Pay the doctor the co-pay, get a written receipt for the copay and file for reimbursement yourself. Then:
  • Submit a claim form
  • Include a copy of the receipt for having paid the co-pay
  • Attach a cover letter, see sample below.



(Name of Insurance Company)
Claims Office
(Address: You can get the mailing address
either from the claim form or by calling the
number on your insurance ID card and
requesting it.)

RE: Marty Gray, Dependent spouse of Dale Gray
Your Insurance ID Number: (Usually the spouse's Social Security Number)
Your Policy Number: (from spouse's insurance ID card)
Reimbursement of Payments Made

Dear Claims Person:

I am insured under the above health insurance policy as a dependent of employee, Dale Gray.

I am also insured under my employer's group health insurance. My employer is Dax Manufacturing Co., Inc. My coverage is an HMO policy through HMO Mutual of Azusa. The group policy number is xxxxx-xxx and my insurance ID with Mutual of Azusa is XXX-XX-XXXX.

It is my understanding that HMO Mutual which covers me as an employee is primary to your company which is secondary under the Coordination of Benefits rules.

I pay a co-pay of $10.00 per visit.

I am requesting that you reimburse me for my co-pays from the savings you realize by being the Secondary carrier. Attached are copies of receipts for ten co-payments I made which total $100. Please mail the check to me as follows:

Dale Gray

If you need more information, please let me know or request it from Dr. No directly. Thank you for your prompt attention to this request.

Very truly yours,



Please share how this information is useful to you. 0 Comments


Post a Comment Have something to add to this topic? Contact Us.

Characters remaining:

  • Allowed markup: <a> <i> <b> <em> <u> <s> <strong> <code> <pre> <p>
    All other tags will be stripped.