Question
Utah
I have two insurances, one I carry though federal retirement and one through my current employer. My question is are there any laws that govern which insurance is pri**** and which is secondary? The companies say the insurance held by my current employer must be pri****. In my case if I have the choice of making my government insurance pri**** I pay the providers very little if any thing. If my employers insurance is pri**** I end up paying more out of my pocket. As I am paying the premiums I would think I would have the choice of which company is designated as the pri****provider.
Answer
I am not sure that there are laws, but that is the rules all insurance follows.
When you have your own insurance through your employer it is always pri****, spouse is secondary. If you were not employed or had no insurance then the insurance through your spouse is pri****. When children are involved, having insurance through both parents then the parent whose birthday falls first in the year is pri**** and the other secondary, unless there is a court order requiring one parent to provide the insurance.
Usually government insurance plans pays out very well, and if your claims are billed properly through both you shouldn't have alot of out of pocket expense anyway.
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Ok did some reading, this is not law but common practice most insurance follows.
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The law does not determine which is pri**** and which is secondary - the insurance contracts do. In any case, you do not get to decide which one you want to be pri**** and secondary.
And can we please stop this foolishness about having the letters m*a*r*y in succession be blanked out? This is supposed to be a professional board, not junior high kids.
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If one of your insurances is Medicare, the law does state which is pri****. Go to and search "medicare secondary". It will tell you how to determine which is pri**** under your circumstances, but each time you go to the dr. they should be completing this questionnaire with you.
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That is wierd. I typed in the full word p-r-i-m-a-r-y (without the dashes) and it comes across with ****. Must be something automatic with the forum.
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Medicare determines pri**** and secondary in their own way.
If patient has her own insurance, and she has two policies of her own, then the carriers will determine who pays first. There is no law governing this.
If there is a couple and each has insurance, they either will follow the birthday rule OR sometimes they determine based on which policy has been active longest.
But, the kicker is that EACH carrier must know about the other one, so that coordination of benefits can be properly caculated. You, as the patient should have very little out of pocket expense, unless you are having services expressly not covered by one or both of your policies.
Medicare has it's own rules based on if the person is employed, if they have/had a large group plan, etc, and also kindey disease (ESRD). Even when the patient has ESRD, the other carrier is usually pri**** for the 30 months following diagnosis and then Medicare picks up pri****. If the patient has a transplant, they can change back.
If the person is employed, having some sort of HMO and Medicare, I do think then the patient can choose which carrier is pri****, but you'd have to find out exaclty what the guidelines are in that case by calling either empire medicare or the local social security office. But I can tell you, once chosen, the patient can't just flip flop back and forth whenever they want to.
That's probably more than you wanted to know. However, none of it is LAW - it's carrier policy and procedure.
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I'm sorry but your statements about Medicare's secondary rules are not correct. MSP is not simply a carrier policy, it is a federal law and consistent across the entire US. Title 18 of the Social Security Act is a law.
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I'm sorry but your statements about Medicare's secondary rules are not correct. MSP is not simply a carrier policy, it is a federal law and consistent across the entire US. Title 18 of the Social Security Act is a law.
Also, the OP would have no reason to call Empire Medicare since he/she is in Utah and Empire does not do business in that state.
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I'm sorry but your statements about Medicare's secondary rules are not correct. MSP is not simply a carrier policy, it is a federal law and consistent across the entire US. Title 18 of the Social Security Act is a law.
well, my MSP statements are correct in New York. I work with it full time, and I have for a number of years so I feel pretty confident that I know how Medicare works.
She probably doesn't need to call Medicare anyways unless she has Medicare insurance. I don't know what it is called anywhere else, Medicare - whatever..... ours is upstate medicare division, but I also referred OP to local social security office, so it could not have been too difficult for anyone to figure out. It was a finger in a direction for more precise answers.
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The Social Security Office does not deal with MSP issues. That is not the place to refer beneficiaries to for questions.