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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Primary vs Secondary Stalemate

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Question: I am employed and have health insurance through my company. When my wife and I got married I added her to my policy. Apparently since she’s under 26 she’s allowed to be on her parents insurance as well. We had a baby and now the bills are starting to roll in. The problem is my insurance is refusing to pay because it’s their “policy” to make her secondary since she’s been with her moms insurance longer. Now her moms insurance is saying that since I married her she’s my responsibility and they become secondary. Both insurance claim to be secondary and neither will pay. My question is ..who is my wife’s primary health care? I don’t care which it is I just want the bills paid

Answer: Sorry, I don’t have a direct answer for you. All states have adopted a specific set of rules, called Coordination of Benefits (COB) Guidelines to determine which health insurance plan pays first when double covered. In your case each insurance carrier is interpreting the guidelines differently and you are at a stalemate. It looks like you will have to go to your state’s Department of Insurance to resolve this. I know, it’s a hassle but your medical expenses will eventually be paid. Incidentally, your mother-in-law’s coverage of your wife will not cover your child going forward, so once this claim is satisfied that policy should be cancelled. Of course, you must add your newborn to your group coverage right away. As you can see, double coverage can cause more harm than good and somebody is paying for the extra coverage.

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