Birthday rule

[rosa_escobar21@hotmail.com]

I keep getting mixed answers as far as the birthday rule goes for insurance sequence for patients. I was taught whoever has a birthday falling first during the year is the primary insurance carrier, and the one with the later birthday is the secondary insurance carrier. Now, I am being told that your primary insurance is the one you carry under your name. Can someone help clarify this?

 

[cindyzam2001@yahoo.com]

Hello, the birthday rule is based on the parent's birthday "Month and Day, not the year. Ex: Mom's bday is 02/15/1980, and Dad's bday is 2/14/1980, then Dad's (14 comes before 15) insurance is primary, unless there is something written in a divorce decree that states otherwise. In other words, Mom could have had the child on her insurance for a longer period of time, and the child could have several doctors that they don't want to interrupt her care, so Mom can request that her insurance be primary. The divorce decree can overrule the initial law.

Step-parents can also cover the child, in which case, their DOB becomes a part of the DOB rule in the absence of their spouse.

Any patient who has dual coverage should coordinate their benefits (COB) with both insurances. I tell the schedulers to make sure that COB is done before scheduling, document the rep's name, and call reference#. Only the policyholder can COB; the office cannot do this. The office can call afterwards to confirm that it was done. This step helps your EHR system from going wacky because it messes up the flow of insurance order.

* You may email me at PacificCoastlineMedBilling@gmail.com if you have any other questions.
website: PacificCoastlineMedicalBilling.com

Cindy

 

[1010medical@gmail.com]

Hello, the birthday rule is based on the parent's birthday "Month and Day, not the year. Ex: Mom's bday is 02/15/1980, and Dad's bday is 2/14/1980, then Dad's (14 comes before 15) insurance is primary, unless there is something written in a divorce decree that states otherwise. In other words, Mom could have had the child on her insurance for a longer period of time, and the child could have several doctors that they don't want to interrupt her care, so Mom can request that her insurance be primary. The divorce decree can overrule the initial law.

Step-parents can also cover the child, in which case, their DOB becomes a part of the DOB rule in the absence of their spouse.

Any patient who has dual coverage should coordinate their benefits (COB) with both insurances. I tell the schedulers to make sure that COB is done before scheduling, document the rep's name, and call reference#. Only the policyholder can COB; the office cannot do this. The office can call afterwards to confirm that it was done. This step helps your EHR system from going wacky because it messes up the flow of insurance order.

* You may email me at PacificCoastlineMedBilling@gmail.com if you have any other questions.
website: PacificCoastlineMedicalBilling.com

Cindy

Determining primary vs secondary for the following scenarios:

Adult child has insurance with their employer and coverage from a parent's insurance plan.
Adult has coverage through their employer and their spouse's employer.

Does the birthday rule apply for adults?