My husband has my daughter (21 year old, full time student) in his health insurance at work, my daughter worked part time and recently she enroll to health insurance with her company but my husband still has her on his insurance. Last month my daughter had surgery and she only submitted her own health insurance which is HMO. Now they only pay partial and leave 2/3 balance unpaid. What should she do? Can she submit her plan with my husband to cover the rest of the bill? Please advise, we are worry since this is huge amount. Thank you
Answer by moderator — June 11, 2009 @ 7:42 pm No CommentsNo comments yet. Leave a comment |
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The first thing you need to determine is why your daughter’s HMO policy only covered 1/3 of the surgery. Did she have a deductible that must first be met? Or, is the insurance company assuming that her coverage through your husband’s employer is responsible for the majority of the expense? With two insurance plans, there will be primary plan and a secondary plan. Since your daughter is the primary insured on the plan with her employer, this insurance company will be primarily responsible. Since she is a dependent on your husband’s plan, this would be the secondary plan. Since we do not know the details of each of these plans, it is impossible for us to determine why there remains a large unpaid balance. Your husband’s insurance may pay a portion of the remaining balance, but that again will depend on the benefits, deductibles and coinsurance levels of that coverage. Once you determine why the primary plan only covered a small percentage, contact the insurance carrier on the secondary plan and ask them how to arrange coordination of benefits to get them to accept a claim for the unpaid portion.
