Let’s say you have coverage from Plan A through the end of the month (from previous job), and coverage from Plan B that starts at the beginning of the month (from new job), so it’s overlapping for the month. However, you hadn’t enrolled in Plan B/gotten your member ID until after you had medical treatments that month, so you weren’t able to bill to Plan B at time of service, so Plan A was billed. To clarify, you have 30 days to enroll in the plan after starting the job, but you’re still technically covered for that month even before enrolling in the plan.
A couple of questions:
You had some copays/deductible fees while covered by both plans but before you enrolled in Plan B, so your bills get sent to Plan A. After enrolling in Plan B and confirming the benefits, you find out that your copays would be lower, and you’re interested in having the deductible costs shifted to Plan B (vs Plan A that will be ending). Can/would you submit the claims to Plan B after they’ve already been processed by Plan A? Would you be able to get the cheaper copay and have the deductibles shifted, or does it not work that way? Would it work for the deductible payments but not copay (since that would require the medical provider returning money to Plan A after receiving the new EOB/payment from Plan B)? I guess I’m curious from both a technical standpoint what is even possible and also from a practical standpoint (i.e. is submitting to both a headache and causes problems etc). You had treatment that on Plan A is just a $100 copay, while on Plan B it’s a $100 copay + deductible/15% of the remaining bill. Is there a way to find out how much the total would be using Plan B before having the bill sent to any insurance company? If the resulting patient responsibility would be $150 for example, I’d rather have the $150 go towards my out of pocket max of Plan B, but if it’s going to be $1000 then I’d rather have the flat $100 copay. If it’s not possible to find out prior to submitting the bill, is it better to just submit to the guaranteed cheaper Plan A? Could/would you submit to both plans? If that’s possible, how would they typically handle splitting the bill? Again, partly curious just in general how this works but also if there are any benefits. If Plan A found out that you were covered by Plan B for the treatments they had already paid for, would they do anything to try to get Plan B to cover some of it? In other words, does submitting to both plans for one treatment open up a can of worms for other treatments that you didn’t submit to both plans?
I hope that was clear, but please let me know if you have any questions. Thanks for your help!
submitted by /u/lifeishard2017
[link] [comments]Let’s say you have coverage from Plan A through the end of the month (from previous job), and coverage from Plan B that starts at the beginning of the month (from new job), so it’s overlapping for the month. However, you hadn’t enrolled in Plan B/gotten your member ID until after you had medical treatments that month, so you weren’t able to bill to Plan B at time of service, so Plan A was billed. To clarify, you have 30 days to enroll in the plan after starting the job, but you’re still technically covered for that month even before enrolling in the plan. A couple of questions: You had some copays/deductible fees while covered by both plans but before you enrolled in Plan B, so your bills get sent to Plan A. After enrolling in Plan B and confirming the benefits, you find out that your copays would be lower, and you’re interested in having the deductible costs shifted to Plan B (vs Plan A that will be ending). Can/would you submit the claims to Plan B after they’ve already been processed by Plan A? Would you be able to get the cheaper copay and have the deductibles shifted, or does it not work that way? Would it work for the deductible payments but not copay (since that would require the medical provider returning money to Plan A after receiving the new EOB/payment from Plan B)? I guess I’m curious from both a technical standpoint what is even possible and also from a practical standpoint (i.e. is submitting to both a headache and causes problems etc). You had treatment that on Plan A is just a $100 copay, while on Plan B it’s a $100 copay + deductible/15% of the remaining bill. Is there a way to find out how much the total would be using Plan B before having the bill sent to any insurance company? If the resulting patient responsibility would be $150 for example, I’d rather have the $150 go towards my out of pocket max of Plan B, but if it’s going to be $1000 then I’d rather have the flat $100 copay. If it’s not possible to find out prior to submitting the bill, is it better to just submit to the guaranteed cheaper Plan A? Could/would you submit to both plans? If that’s possible, how would they typically handle splitting the bill? Again, partly curious just in general how this works but also if there are any benefits. If Plan A found out that you were covered by Plan B for the treatments they had already paid for, would they do anything to try to get Plan B to cover some of it? In other words, does submitting to both plans for one treatment open up a can of worms for other treatments that you didn’t submit to both plans? I hope that was clear, but please let me know if you have any questions. Thanks for your help! submitted by /u/lifeishard2017 [link] [comments]Read Morer/HealthInsurance