under ca law the fathers insurance is primary due to the fact that he is older . how or could it be possible to have the the mothers insurance primary ? we what the mothers insurance company first due to the fact that it has always been used for the baby. we are now in the hospital and out of network with the fathers insurance and they will not cover it due to that fact. The er ntransfered us to an out of network hospital so how can we resolve this? his insurance is first adn they already denied the claim.
Insurance - 5 Answers
Random Answers, Critics, Comments, Opinions :
1 :
If the law states that one is primary, then that is the way it will be. The other would only be tapped if and when the claim exceeds the primary coverage. All you have to worry about it to be sure you never attempt to make a claim on the secondary until the primary is exhausted, or, if the claim is not covered by the primary but can be by the secondary.
2 :
Why? It only matters to the insurance company. It should matter to you. If you get a $100 invoice, it'll travel to company A first then to B and then you pay. If it goes to B first and then A it wouldn't make MUCH of a difference to you. If you want to keep it simple keep one plan.
3 :
The choice of whose plan you use is not yours but the state. Laws govern whose policy is primary. So, you use the father's coverage first, and then you use the mothers' insurance for what is not covered. You can file a claim under both, but when you use the secondary insurance, they will want to know what the first coverage paid or did not pay, and why not. This is called " coordination of benefits."
4 :
The "birthday law" isn't about AGE, it's about what day of the year the birthday comes FIRST. So clearly, dad's birthday ocurrs earlier in the year than moms. The ONLY way to get mom's policy primary, is to cancel child from dad's policy during the next open enrollment. If the transfer happened, because there wasn't a local in network hospital that could provide a specialty service (like a pediatric nephrologist), you appeal to dad's insurance to have it covered as a medical necessity on an in network basis.
5 :
You do not have to change which is primary. The secondary will pay the claim if (1) the primary denied it, and (2) the secondary would have covered it if you did not have the primary.
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