General Category > General Questions

Issue with secondary insurance

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PsychBiller:

I have encountered an unusual situation regarding secondary insurance, and I would very much appreciate any input.

We have a patient (child) whose parents are divorced.  As part of the divorce agreement the father is required to provide insurance for the child, which he does (United Healthcare).  The patient's mother also has secondary insurance for the child (Medicaid).

The issue is that the patient's mother has not notified the patient's father that there is a secondary insurance in place. 

Is this legal? should the father not have the right to use the secondary insurance also for his child?

RichardP:
This is my initial thought upon reading your post:  how do you know that the mother has a secondary policy on the child?  The only way that we would know this is if the doctor had a copy of that secondary insurance card.  We have a pediatrician as a client, so we run into situations similar to this.  We put all insurances that are given to the doctor for a patient into the insurance part of our billing software.  When the child sees the doctor, and the doctor gives us the fee slip, we don't know (nor do we care) which parent or friend brought the child in.  We simply bill all insurances we have on file.

Is this not the case in your situation?  Or am I missing something here.

PsychBiller:

I know that she has secondary insurance because I have copies of both cards on file.  I am the practice manager, the mother let slip to me in conversation that the father does not know about the other insurance.

DMK:
The child's care should be billed appropriately to the insurance policies the doctor's office has.  If the father's is primary, and the wife's is secondary, the doctor's office should bill accordingly.  If their is a remaining balance due after both insurances have responded, whoever is the financially responsible party (listed on the intake form) should be billed.

DO NOT get involved in the politics of divorce, this is strictly business, and the office needs to bill it according to the law.

PsychBiller:

I AM NOT getting involved in anything, I do not concern myself with the private lives of patients....the appointments are billed according to the insurance(s) on file.

I simply asked if it was legal for there to be a primary and secondary insurance in place for a child and only one parent have the benefit of using both.

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