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double coverage

  1. #1
    Question double coverage
    Medical Coding Books
    patient is covered thru his employer under BC and is now covered thru Blue Shield Covered California. at the time time of his enrollment he had no other inhsurance. can you tell me which one would be primary?

  2. #2
    Default
    If I am understanding your question, the patient is still employed full-time and carries employer benefits, right?

    In this scenario, the full-time employer insurance would be billed primary and the secondary would be the insurance through California. The only other rule for this is the birthday rule. If his wife is covered through a full-time employer plan and her birthday is prior to his, then her insurance would be primary and his insurance would then fall to secondary.

    Hope this helps!!!
    Amy Pritchett,
    BSHA, CPC, CPMA, CPC-I, CDEO, CANPC, CEDC, CASCC, CRC, CMDP, CMPM, CCS, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS
    2017-2018 Secretary of Local Mobile AAPC Chapter
    2015-2016 President of Local Mobile AAPC Chapter

  3. #3
    Default double coverage
    exactly what we thought. thank you for confirming.....

  4. #4
    Location
    Baton Rouge
    Posts
    1,241
    Default
    Quote Originally Posted by Amy Pritchett View Post
    If I am understanding your question, the patient is still employed full-time and carries employer benefits, right?

    In this scenario, the full-time employer insurance would be billed primary and the secondary would be the insurance through California. The only other rule for this is the birthday rule. If his wife is covered through a full-time employer plan and her birthday is prior to his, then her insurance would be primary and his insurance would then fall to secondary.

    Hope this helps!!!
    Isn't the birthday rule for establishing primary/secondary coverage for children? If 2 married people are both double-covered due to group coverage for both. Each spouse's own group policy is primary, their spouse's is secondary.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  5. #5
    Default
    Quote Originally Posted by mhstrauss View Post
    Isn't the birthday rule for establishing primary/secondary coverage for children? If 2 married people are both double-covered due to group coverage for both. Each spouse's own group policy is primary, their spouse's is secondary.
    The birthday rule is indeed only for minor children. If you are an adult and you have your own insurance your spouses will never be primary for you.

  6. #6
    Default
    No. If you are employed with med coverage your own insurance is always primary.
    The exception is if you are disabled and on Medicare and your spouse is working and has coverage with a # of employees over 80 (it might be 100) then your spouses coverage is primary.

    Dependent coverage follows the "birthday rule".
    Teresa Kelley, CPC
    Detroit, MI AAPC Chapter member

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