Primary Insurance and Secondary Insurance

Primary Insurance:

The Primary insurance company is the one who is responsible for paying the claim first. If patient is having more than one active insurance company at the time of service, then the Medical billing company must first submit that claim to primary insurance before submitting it to secondary insurance and then tertiary insurance.

If patient is having more than one insurance at the time of health care service, then patient must update all the insurance policy details and the order of insurance like primary insurance, secondary insurance and tertiary insurance in order to ensure 1) No duplicate payments, 2) Paid by correct payer respectively and 3) not to exceed more than the covered charges.

Secondary Insurance:

The secondary insurance company is the one who is responsible to pay the balance after the primary insurance has paid or denied the claim.

Claim must be submitted to secondary insurance for the balances along with primary insurance EOB to process the submitted claim correctly. If suppose claim submitted to secondary insurance without the primary insurance EOB, then the claim will be denied as need primary insurance EOB or the claim will be covered by another payer.

Below are the rules used to determine the primary insurance, secondary and tertiary insurances:

COB- Coordination of Benefits Rules to determine primary and secondary for insured:

If patient is having multiple health plans, then will use COB rules to decide which insurance company will be responsible for primary and secondary payment respectively. This COB should be updated by the patient to provider and also with insurances.

Birthday Rule for Children to determine primary and secondary insurance:

Birthday rule is a rule, which is used in determining the primary insurance and Secondary insurance for a child when the parents are insured. It is calculated as per coverage of the parent whose birthday(Only month and day, not year) comes first in the year is considered to be your children’s primary insurance coverage.