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ready123go July 25th, 2010 10:01 AM

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?

green_rd July 25th, 2010 05:22 PM

Ready - I'm no insurance expert, but I believe a either insurer could either directly pay the medical facility or the insured. Many US employer's health policies do not provide coverage when traveling internationally (unless for business purposes.) That, plus the cost of items such as medical evacuation and cancellation issues.

Lakers Fan July 25th, 2010 08:53 PM

I spent most of my life working in the health insurance industry . The primary carrier pays a percent of the usual and reasonable charge as determined by the insurance carrier .If there is an unpaid balance most carriers will allow for their usual and reasonable and pay a percentage of the balance .However ,some carriers take the position that if the charges exceed the urc of the primary then they will not pay as secondary .

ready123go July 30th, 2010 11:59 AM

Thanks to all who responded.

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