Secondary insurance coverage for supplies

I now find myself in the novel position of having both primary and secondary insurance coverage. My primary coverage is horrible and monthly copay (they will only allow me to get ONE month at a time!) for my Bleep DreamPorts is about the same as my secondary coverage copay for a THREE month supply!

Does anyone here have experience with having coverage with primary and secondary insurance for CPAP supplies? If so, how does it work for you? I do understand each situation is different, just trying to get an idea.

TIA

I don't understand how you can have 2 coverages. Usually an suppliment will not pay if it's covered by primary

What kind of insurance are we talking about here? Two different employer provided insurance plans maybe?
Whose is primary and whose is secondary.?

Some insurance plans adhere to the strict one month replacement thing and some others allow DMEs to go ahead and supply at the 3 month thing. Medicare will actually allow a DME to ship a 3 month supply of something like cushions or nasal pillows despite the official 2 per month allowance. I think mainly to expedite things for everyone.

I suspect that whoever you have that is primary just wants to be a hard ass about things. Not much you can probably do about it unfortunately and will just be making more work for everyone but they get to make their own rules.

I am not on Medicare, so it's not a supplement. Regular health insurance through employers.

My primary coverage is through my (former) employer. But I am also covered through my husband's insurance, self + 1, which would be my secondary coverage.

We used to be covered only under my husband's plan, which was great, until about a year ago. They allowed me to get 3 months supplied at a time. When we lost that coverage (long story), I was able to get us coverage through my employer, but the plan is poor and only allows 1 month at a time. It is actually more cost effective for me to pay for my Bleeps out of pocket! Ideally, I would love it if I could just go through his insurance but I'm pretty darn sure they won't allow that to happen! New coverage just started so I haven't been able to get any answers yet and I just wondered if, with the wealth of knowledge on this board, there might be someone else in a similar situation.

It's a mixed bag of worms when 2 employers provided insurance is involved...or heck, with any 2 insurance plans outside Medicare and traditional supplements. Both of them want the other to pay the bulk of the bill so they fight over who pays what. The person getting screwed is the patient. The primary insurance does what they damn well please and then the secondary does what it damn well pleases.

I have sort of the same situation in terms of dental insurance. I am on my husband's dental insurance plan. It pays for cleanings and preventative care at 100% and no deductible....I have a little bit of dental coverage on my Advantage plan but it has a $35 deductible with it and doesn't pay squat. What the hell...anyway since my name is on the Advantage plan it is considered primary and must be filed first...and I gotta pay the $35 first...and then they file my husband's. Now will I ever see the $35...it's doubtful. It should be refunded to me but I doubt I will ever see it. That's okay...the next dentist visit there will be "I don't have that plan anymore and you can delete it from the records"..
It doesn't pay squat anyway. I will fix that little problem.

I don't know if this will work, but give it a try.

Order a 3 month supply. Submit the bill to your primary, they will only pay for 1 month. Then submit the bill to your secondary and see if they will pay the co-pay on the first month and all of the second and third month.

There is a risk that you will be out of pocket for 2 months if the secondary won't play along, but worth a try once to see if it works.

Janknitz wrote: ↑

Fri Jul 24, 2020 12:21 pm

I don't know if this will work, but give it a try.

Order a 3 month supply. Submit the bill to your primary, they will only pay for 1 month. Then submit the bill to your secondary and see if they will pay the co-pay on the first month and all of the second and third month.

There is a risk that you will be out of pocket for 2 months if the secondary won't play along, but worth a try once to see if it works.

I actually was thinking of doing just that!

I wanted to get that kind of insurance too, but I had to get a supplemental plan. I have a disability but the state does not legally pay anything, even though the law is in place for all states.

???

If you are on SSDI (Social Security Disability Insurance) after two years you automatically get Medicare. And generally you can get a supplemental plan for Medicare. If your income and your assets are low enough, you can get Medicaid AND a supplement, and (at least in California) Medicaid will even pay the premium for your supplement. So your Medicare would be primary, your supplement secondary, and Medicaid picks up the rest (if any). If your income isn't quite low enough, you may still get Medicaid, but with a "share of cost".

Generally, there's not much benefit except as catastrophic insurance to Medicaid with a share of cost, because it usually requires you to spend all of your income except a certain amount (i.e. $600) on medical care before the state picks up a dollar. That may be what you are referring to. The share of cost makes NO logical sense. Here's an example:

In California you get Medi-Cal (California's version of Medicaid) if your income is below the Aged and Disabled Federal Poverty Limit (currently $1,482 a month) with no share of cost. But if your income is even a little above that (e.g. $1,485 a month) you have to pay out all but $600 in each month ($885 in this case) JUST for medical care before Medi-Cal will pay even $1 (essentially you have an $885 monthly deductible!). It's hard enough trying to live in California on $1,482 a month, nearly impossible on $600 a month. But that's what some people deal with if a benefit like SSDI pushes them over the Aged and Disabled Federal Poverty Limit. There are some strategies that can pull the income below that line or programs that give people more help, but you have to find good advice to learn how to avoid the share of cost.

Forwardres, there are various advocacy agencies that may help you solve this issue if that's what you are referring to. Start with your state's SHIP counseling program--if you are on Medicare you can find the number on the back of your "Medicare and You" booklet or find it at medicare.gov.

When two employer-based health plans coordinate benefits, the overall result is often lower out-of -pocket costs for the patient.

DME suppliers are experts at squeezing every last available penny out of insurance. Make sure your DME knows which insurance is primary and which is secondary, and ask them to work their magic.

randye80 wrote: ↑

Tue Dec 21, 2021 10:00 am

When two employer-based health plans coordinate benefits, the overall result is often lower out-of -pocket costs for the patient.

DME suppliers are experts at squeezing every last available penny out of insurance. Make sure your DME knows which insurance is primary and which is secondary, and ask them to work their magic.

That's in an ideal world. Just wait until you have those 2 insurance plans fighting over who is primary and who is secondary and neither one wants to pay and the patient gets collection calls daily from providers wanting to get paid.
In real life it's far from an ideal world and I speak from experience as the spouse of one of those people.
My husband is still fighting with the insurance from a procedure done in early July. It's a nightmare and extremely stressful.
They want us to pay over 15K for something that we should have zero pocket out of expense if the insurance would quit fighting and pay like they are supposed to.

Have you tried contacting your state's insurance regulator to see what the rules are and if they have any advocacy services? Or file a complaint against both?

Also remember to ask for and review the Evidences of Coverage (the contract with your insurer you never see unless you specifically request a copy). It's likely to be spelled out in each insurer's EOC, but if they contradict each other you have troubles.

Contact your state department of insurance.
Make an appointment, so they know you mean business.
It is their job to help the consumer.
Insurance companies try this sh*t all the time.
Maybe they need to get their knuckles smacked.