Doesn't it depend on whether you're par/non-par, plan pays UCR or contractual amount? I know it's confusing, but one of the scenarios in my BCBS handbook, shows both insurances paying, as long as the combined payment does not exceed the billed amount. "Primary plan pays on the basis of UCR and Horizon BCBSNJ pays on the basis of a contractual fee schedule, the primary plan pays its benefits without regard to the other coerage and HOrizon BCBSNJ pays the difference tween billed charges and athe benefits paid by the primary plan up to the amount we would have paid if primary."
Billed: 1250
Primary paid UCR: 336
Horizon fee schedule if primary: 422
Provider would get a total of 758, which is below the billed amount.
It also says that the covered person is only liable for cost sharing under the secondary (BCBS) if she has NO liability for cost sharing under the primary, and total payments of the primary and secondary are less than billed charges.