Coordination of Benefits for HMO and PPO

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So next year my sister is going to be dually insured. Kaiser HMO through our mom and Anthem PPO through our dad. This is in California.

I know that for primary vs secondary you use the birthday rule for children, so Kaiser would be primary because my moms birthday comes before my dads.

But my sister wants to see a therapist outside of Kaiser because of their bad reputation for mental health services. How does that work? Any therapist is going to be denied by Kaiser anyways, so does she still need to bill Kaiser and then Anthem? I don’t see the point of jumping through all of Kaiser’s hoops just for them to deny her. If she only billed Anthem is there any way they would find out? Or what would the repercussions be?

submitted by /u/mecheepie
[link] [comments]
So next year my sister is going to be dually insured. Kaiser HMO through our mom and Anthem PPO through our dad. This is in California. I know that for primary vs secondary you use the birthday rule for children, so Kaiser would be primary because my moms birthday comes before my dads. But my sister wants to see a therapist outside of Kaiser because of their bad reputation for mental health services. How does that work? Any therapist is going to be denied by Kaiser anyways, so does she still need to bill Kaiser and then Anthem? I don’t see the point of jumping through all of Kaiser’s hoops just for them to deny her. If she only billed Anthem is there any way they would find out? Or what would the repercussions be?
submitted by /u/mecheepie [link] [comments]Read Morer/HealthInsurance

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