Health Insurance Question

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Topic Author
Pistachioicecream
Posts: 53
Joined: Sun Dec 09, 2012 11:08 pm

Health Insurance Question

Post by Pistachioicecream »

Are there any health insurance experts in the audience?

My friend had been told she was going to be layed off from her job at the end of last year (12/2017). To prepare for this, her husband enrolled in the medical & dental insurance offered through his job, beginning in January 2018. As it turned out, my friend did not get layed off and she is still with the same employer. Meanwhile, the husband and son have each gone to the doctor during January 2018 and used the wife's employer-subsidized insurance as in the past. I pointed out that as both she and her husband have coverage, her husband's insurance was now "primary" for him, as well as for their son (his birthday is in the first 6 months of the year). The wife has asked me if she needs to notify her insurance company about the mistake.

I am thinking that the proper thing is for the wife to call her health insurance company and explain what happened, with the expectation that the company will ask that any funds paid for the husband's and son's visits be reimbursed - and then my friend should get the bills reissued from the physicians' offices (I doubt they will resubmit for them) and send to husband's insurance company? Or, should they just start using the husband's insurance next time he or their son go to the doctor and/or need to have prescriptions filled? Or, ________ (please fill in the blank with your suggestions).

Thanks for any insight you're able to provide.
Pistachio
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Pajamas
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Joined: Sun Jun 03, 2012 6:32 pm

Re: Health Insurance Question

Post by Pajamas »

What a mess. I would just give all of the insurance information to all of the providers' offices and both insurance companies and let them deal with the coordination of benefits. It will probably take a while to straighten it out and it may get botched up more than once. The bigger issue is having two plans when only one is needed and presumably they want to and hopefully will easily be able to cancel one or the other. When they communicate with anyone about this, they should be very clear about the start dates and end date of the coverage that is being cancelled to avoid extra delays.

The parents would each be covered by their own employer's coverage as primary with their spouse's employer's coverage as secondary. The child's primary coverage would be the primary coverage for the parent whose birthday comes first on the calendar with the other as secondary. I don't think the child's birthday falling in one or the other half of the calendar has anything to do with it.
Topic Author
Pistachioicecream
Posts: 53
Joined: Sun Dec 09, 2012 11:08 pm

Re: Health Insurance Question

Post by Pistachioicecream »

Thanks for your comments Pajamas. You are correct, the child is considered primary based on whichever parent's birthday comes first in the year. I mis-wrote :wink:

The parents are not so concerned about having duplication of coverage (because of being able to submit the out-of-pocket remainder to the other's insurance company and thereby getting the entire bill covered). The question they are hoping to get answered is if it okay to just use the correct insurance the next time the husband or son go to the doctor/have prescriptions filled, or do they need to first let the wife's insurance company know what happened?

Pistachio
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Pajamas
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Joined: Sun Jun 03, 2012 6:32 pm

Re: Health Insurance Question

Post by Pajamas »

If they cancel one coverage it wouldn't be an issue which coverage they use in the future, but no they should not ignore it. They should let the wife's insurance company know what happened. They didn't intentionally do it in the first place, but choosing not to report it so it can be corrected would be intentional.
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lthenderson
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Joined: Tue Feb 21, 2012 12:43 pm
Location: Iowa

Re: Health Insurance Question

Post by lthenderson »

Not your question but if I were in their shoes, I would keep the family on the husband's insurance once this all gets sorted out in case the layoff at the end of the year turns into the layoff at the end of February.
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Epsilon Delta
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Joined: Thu Apr 28, 2011 7:00 pm

Re: Health Insurance Question

Post by Epsilon Delta »

A change in employment resulting in a change in coverage is a qualifying event that would almost certainly give you a special enrollment period for the other spouse's employer's insurance. You don't need to make changes based on anticipated job loss if you're goal is simply to ensure you maintain coverage.

If you have significant out of pocket expenses it may be a different matter, since if you switch insurance mid year you may end up having to pay both deductibles etc.
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