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  1. #1
    Join Date
    Jan 2014
    Posts
    3

    Default Health Care Expenses With Primary and Secondary Health Insurance

    My question involves insurance law for the state of: California

    I married September 2013 and at that time my wife signed me up to be on her health insurance plan because it is a better plan. I'm just now (Jan 1, 2014) canceling my insurance through my job now that I know hers is in effect. They overlapped by a few months.

    In October I became ill and had about $50,000 worth of hospital bills. My work insurance policy paid almost all of the bills. I didn't realize at time, or even think about it, that my wife's plan was also covering me. My wife's plan had gone into effect just a couple days before I got sick, but at the time we had not yet received a card or any official indication that I was insured under her plan in addition to mine. Without realizing we were making a mistake we never told either insurance company or the hospital that I had a second plan.

    I'm 90% sure my plan would have been my primary plan since it is my plan from my work. Although I'm not 100% sure? What should I do now that I realize I made this mistake? Should I contact one or both insurance companies and let them know I was ignorant of the rules, and my dual coverage, and didn't mention this second plan? Additionally, if I do confess to the insurance companies what should I expect is going to happen? Will they re-open all their payments and make new determinations regarding how much they should have paid? Will I be penalized for not informing everyone up front of the other policy? Am I better to just keep quiet?

    I never meant to make this mistake and I'm willing to do whatever I need to do to fix it. What should I do? I would really like to be up front and tell the insurance companies, but I'm afraid of opening pandora's box of problems.

    Thanks in advance.

  2. #2
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,097

    Default Re: I Didn't Know I Had a Second Insurance Plan when I Had Expensive Surgery

    I am 100% sure that your plan would have been primary. Which means your plan would have paid first anyway and the amount they would have paid would NOT have been affected by knowing you had a secondary policy. It is the secondary, not the primary, plan that adjusts the amount they pay.

    How much, roughly, is left unpaid and have you already paid any balances?

  3. #3
    Join Date
    Jan 2014
    Posts
    3

    Default Re: I Didn't Know I Had a Second Insurance Plan when I Had Expensive Surgery

    I paid about $400 total and all balances are currently paid. I'm just concerned that if I don't come forward with my mistake they'll claim I misrepresented my status and take back all their payments to the health care providers leaving me with a massive bill.

    Assuming they were responsible is there any downside to just letting it go and not bringing it to their attention? Or, by not coming forward with this information now that I know am I going to cause myself a problem? The human resources people at my company can't seem to give me any insight.

  4. #4
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,097

    Default Re: I Didn't Know I Had a Second Insurance Plan when I Had Expensive Surgery

    As I said, it's a guarantee that your own plan is primary over your wife's, so your plan has not paid anything differently than they would have if you had told them about her coverage on the first day. Your plan is primary for you; your wife's plan is primary for her; if there are any children covered on both policies the COB (Coordination of Benefits) policy on both plans will determine which plan is primary for them. Most (not all) of the time it is the plan of the parent whose birthday falls earlier in the year.

    There would be no reason for your insurance carrier to "take back" their payments since they haven't paid anything any differently than they would have paid otherwise. But since it's bothering you, I don't see any downside to your contacting them and telling them plainly that you have only just been made aware that there was a secondary policy, and asking what the procedure would be to have the bills submitted to the secondary carrier. I promise you it won't be the first time they've heard that question.

  5. #5
    Join Date
    Jan 2014
    Posts
    3

    Default Re: I Didn't Know I Had a Second Insurance Plan when I Had Expensive Surgery

    Thank you for sharing your expertise. I feel better already.

  6. #6
    Join Date
    Sep 2010
    Posts
    19,247

    Default Re: I Didn't Know I Had a Second Insurance Plan when I Had Expensive Surgery

    Sometimes you have to "remind" them that they are primary. Sometimes they'll attempt to take the easy way out.

  7. #7
    Join Date
    Jun 2006
    Location
    Massachusetts
    Posts
    24,097

    Default Re: I Didn't Know I Had a Second Insurance Plan when I Had Expensive Surgery

    Well, since the poster's plan is not only the one through his employment but also has been in place longer, they wouldn't have much of a basis to protest.

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