A patient who has two health insurance policies has dual coverage. Dual coverage is common between spouses and/or parents and their children. Sometimes both policies are through the same carrier, and sometimes not.

 

When a patient has dual coverage, it's important to understand coordination of benefits.

 

Coordination of Benefits

If two insurance policies are in play, who pays first?

 

Your patient may incorrectly assume that they choose which is primary vs. secondary. This is incorrect: it's not up to the patient.

 

Patients with dual coverage must contact both carriers to update their coordination of benefits. The carriers will coordinate with each other to determine which is primary vs. secondary.

• For spouses, your patient's healthcare policy will generally be designated as their primary, and their spouse's as the secondary.
• It's not as straightforward for parents and their children. Due diligence will save you administrative work later.

 

Filing Claims

Claims should first be filed to the primary carrier. After processing the claim, the primary carrier will send remittance or an explanation of benefits (EOB).

 

In order to file a secondary claim, the remittance or EOB must usually be included with the secondary claim. We generally file secondary claims via mail, with a couple notable exceptions:

• If both policies are through Providence, the secondary claim is automatically generated and processed.
• Regence BCBS OR / Regence BS WA / Regence BS ID does not accept paper claims. We must transcribe the EOB details in order to e-file.

 

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Frequently Asked Questions

What does the secondary carrier cover?

The secondary carrier generally reimburses the patient's primary out-of-pocket expenses, including copays/coinsurance. They may also cover services not paid by the primary carrier.

 

Do I pay Acubiller twice when a patient has dual coverage?

Yes. Filing for patients with dual coverage involves two claims. You're charged once for the primary claim, and once for the secondary claim.

 

Do I HAVE to file a secondary claim? Why should I pay Acubiller twice for this?

There's a contractual reason and a financial reason.

• Contractual. By signing our contract, you've agreed that Acubiller will file all of your claims. If the patient submits the secondary claim, that would violate our contract.
• Financial. The secondary carrier cannot reimburse the patient unless a secondary claim is filed.