Question
What is the name of your state? Illinois
Hello I have 2 similiar issues I really need advice with. My daughter had to have stitches to her face in the ER due to a dog bite from our family dog in July of 2004. My younger daughter had to have intestinal surgery at 6 weeks to correct malrotated intestines. Both times I submitted my insurance information to the Doctors. I have carried insurance on myself and my children because I worked full time and had excellent benefits, however after we were married my husband enrolled our family in his insurance plan as well. Apparently he is considered to carry primary insurance because his birthday is June of 1963 while mine is December of 1974 and his occurs first in the calendar year. My insurance had paid the costs I had double checked both had zero balances however a little over a year later on both accounts they took back payment and the offices called asking for our primary info i sent them cards (it took a few weeks due to the fact that our third child arrived a month early and we were quite busy with all that entails, we did not become informed until we were received letters from collection agencies that my husbands insurance had denied the claims since a year has past. We have appealed and both have denied them. Mine due to being secondary only and His due to it being more than a year from the date of service. I cannot believe that we paid both premiums and now nobody wants to pay. To make matters worst it seems my husbands plan was a employer funded plan that ended its contract in 2004 and all funds were withdrawn on Dec 31 2005. I dont know what to do or where to turn but this situation just does not seem right to me? Do I have any rights??? Please help!@
Answer
Based on what you have posted, your husbands plan WAS primary, and should have been filed first. If your carrier paid as primary, that was incorrect and they are entitled to any overpayment. It appears they have already handled that by getting a refund from the provider.
If the claim was not filed with the primary carrier in a timely basis, they have every right to deny the claim.
You gave incorrect information to the provider. You relied on the provider to file on your behalf. It appears that your carrier has taken the proper action. It also appears your husbands carrier has acted according to their contract.
Sounds like you need to start making payments to the providers.