I have dual pharmacy coverage for my medications. What insurance company pays for my drugs?
I have dual pharmacy drug coverage. My drug coverage has a higher co-pay than my husbands. Do I have to use my pharmacy coverage if my spouse's pharmacy coverage is cheaper for drug co-pays? I just received a big check for drugs my insurance paid for that were billed to my husbands insurance company. Should that check go to my husband's insurance company?
I think that is illegal, neither one may pay. Send the check to your husbands insurance company and check of the legality of your coverage situation.
It is not illegal to have two health insurers, as one answerer wrote. In fact, many folks have dual coverage. However, to submit a claim to each insurer as if they're both primary and not tell them another insurer covers you would, at the very least, be wrong. Under some circumstances, this would be insurance fraud. So it's very important that you follow the provisions of both policies and inform both insurers that another insurer covers you.
Most insurers conform to the National Association of Insurance Commissioners (NAIC) Coordination of Benefits (COB) model. This will mean that the COB provision in most policies require that your policy be your primary and your coverage under your spouse's policy be your secondary. (Caution: this may be reversed if the plan is "self insured" by your employer, so check the COB provision.)
Because this is a policy (contract) provision, you do not have the ability to choose which policy is your primary. Assuming both policies agree that your coverage is primary, you should tell your pharmacy to submit the claim to your insurer FIRST, then submit the remaining balance to your secondary insurer. Under most circumstances, the primary insurer will pay up to its "allowed amount" for the drug or service, leaving you with a co-pay or co-insurance. This can then be billed to the secondary insurer. How it pays the remaining benefit depends upon the wording of the contract.
In all likelihood, the check you received should be used to pay the pharmacy for your prescriptions; if you paid for them up front, then the money is yours. Read the "Explanation of Benefits" that accompanied the check for further information; if you're unsure, call the insurer. You didn't specify whether your insurer paid first and this check comes from your husband's insurer as secondary.
If the claims were only sent to your husband's insurer and the COB provision in his policy makes it clear this is your secondary coverage, you're walking a very dangerous path. In most states, insurers are able to retroactively deny previously approved claims and retract the money from health care providers or from you, depending upon who received the payment. You may end up owing hundreds of dollars to the secondary insurer, in that case.
I hope this helps.
I would check both policies for "coverage terms". Usually the insurance that was started first is the primary and then after its secondary, so on and so forth. As for the check I would send it in to his insurance company. If his deductible is met then in more than likely the money would be your reimbursement. Also if the language in the policies gets to confusing, call your insurance company and his and they will be able to explain in detail who has to pay what. In some circumstances they can bill 1/2 the amount to his insurance and 1/2 to yours. It all depends on coverage, deductibles, and co-pays.
no that money is yours. they rebilled your prescriptions to his insurance and gave you back the difference you paid between your copay and his copay. your insurace gets their own cut, its the dispensing fee from the pharmacy.
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