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Old July 25th, 2010, 11:01 AM
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ready123go ready123go is offline
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Join Date: Oct 2009
Location: Metro Detroit
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Default Primary vs. Secondary Insurance Provider?

I hope my statements and questions are clear. I would like to fully understand the process by which a primary carrier fulfills its function or obligation vs. the process by which a secondary carrier fulfills it function or obligation.

As I understand it, a secondary provider will not pay until a primary has denied a claim. No problem there. If a claim exceeds the maximum amount covered by the primary policy, a secondary will pay the outstanding balance (not including the deductible from the primary plan) up to their coverage limit. Makes sense.

Here the confusion sets in. I have read in some posts that primaries pay the service provider (i.e. medical facility) directly, while a secondary simply reimburses the costs incurred by an insured individual. Is that accurate? Additionally, I have read if there is no primary policy, then a secondary policy kicks in as if it were a primary. If so, how does this function? How does a secondary meet its obligation? Does the secondary insurer then pay service providers directly? I would assume they do not, but how does it work?

What are the pros and cons of both primary and secondary insurers?
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