Hi all,
My wife and I are both lucky to have great insurance plans through our employers. Hers provides Kaiser (NorCal) and covers the premium, and mine is a Blue Shield of CA high deductible PPO plus an HSA to which my company contributes annually to cover the deductible.
Last year we got pregnant and I switched my wife to my plan, for a number of reasons but the main one is that we didn’t have a great experience at Kaiser for the birth of our first daughter. I also have past trauma at Kaiser and don’t wish to go back if at all possible.
So we’ve been going to a BSC in-network provider since January for prenatal care and only now at 38 weeks in the pregnancy have we discovered that BSC has been rejecting all claims thus far. When we talked to the claims department they said the rejections were due to Kaiser being listed as her primary.
This is our first experience with coordination of benefits and dual coverage, so we were really confused about why BSC couldn’t be set up as her primary, but after reading the NAIC regulations and COB rules, and talking to a friend in the industry, this makes more sense now—or is at least well defined.
I guess the outstanding question for us is: Who do we talk to to get the coordination of benefits set up correctly? Do we tell the provider to issue claims to Kaiser first as the primary and then let it come back to be resubmitted to BSC as the secondary? Is this something the provider’s billing department usually handles? Or is this something BSC is supposed to coordinate directly with Kaiser on? It seems like from what I’ve read, the primary acts as though it is the only insurer, so do we need to contact Kaiser as well?
Hoping to get more clarity tomorrow when I contact my company’s broker, but I’m sitting around worried, so I thought I’d post here in the meantime. Any clarity around how COB plays out in a step by step workflow would be super helpful. I’m having trouble with all the terms and keeping them straight!
Thanks a ton.
submitted by /u/dzachary
[link] [comments]
Hi all, My wife and I are both lucky to have great insurance plans through our employers. Hers provides Kaiser (NorCal) and covers the premium, and mine is a Blue Shield of CA high deductible PPO plus an HSA to which my company contributes annually to cover the deductible. Last year we got pregnant and I switched my wife to my plan, for a number of reasons but the main one is that we didn’t have a great experience at Kaiser for the birth of our first daughter. I also have past trauma at Kaiser and don’t wish to go back if at all possible. So we’ve been going to a BSC in-network provider since January for prenatal care and only now at 38 weeks in the pregnancy have we discovered that BSC has been rejecting all claims thus far. When we talked to the claims department they said the rejections were due to Kaiser being listed as her primary. This is our first experience with coordination of benefits and dual coverage, so we were really confused about why BSC couldn’t be set up as her primary, but after reading the NAIC regulations and COB rules, and talking to a friend in the industry, this makes more sense now—or is at least well defined. I guess the outstanding question for us is: Who do we talk to to get the coordination of benefits set up correctly? Do we tell the provider to issue claims to Kaiser first as the primary and then let it come back to be resubmitted to BSC as the secondary? Is this something the provider’s billing department usually handles? Or is this something BSC is supposed to coordinate directly with Kaiser on? It seems like from what I’ve read, the primary acts as though it is the only insurer, so do we need to contact Kaiser as well? Hoping to get more clarity tomorrow when I contact my company’s broker, but I’m sitting around worried, so I thought I’d post here in the meantime. Any clarity around how COB plays out in a step by step workflow would be super helpful. I’m having trouble with all the terms and keeping them straight! Thanks a ton.
submitted by /u/dzachary [link] [comments]Read Morer/HealthInsurance