Wiki Primary vs Secondary insurance

[Kar116]

Hope someone can answer my question quickly for me. If biological father has insurance as well as the step dad, would the biological father's insurance be primary? We just got a recoupment EOB from the insurance we thought was primary. Thank you for your help.

Kar116

 

[bonn715]

there is unfortunately more to it in this circumstance.
If the child is in the custody of the mother, the stepdad's is primary. if there is a court order that specifically says the PRIMARY coverage, not meaning that they have to have coverage but that the insurance has to be first for the child, it is the bio-dads.
and on top of that, any insurance has the right to coordinate benefits with the other insurance. if they have agreed to be primary coverage then they can be.
Sometimes it takes a a three way call to both insurances but you can usually tell by the processing if you have access to other dates. Most likely you will need to contact the parent to get more clarity on the filing order.
I believe CMS.gov is where i originally found this info and they also had a Web-education thing (spaced what they are called, sorry, but under outreach and education)

 

[laurijean]

Hope someone can answer my question quickly for me. If biological father has insurance as well as the step dad, would the biological father's insurance be primary? We just got a recoupment EOB from the insurance we thought was primary. Thank you for your help.

Kar116

If the Mother is the custodial parent and the minor is living with the step father, then the step father's Ins would be primary

 

[adminbps2502]

Hope someone can answer my question quickly for me. If biological father has insurance as well as the step dad, would the biological father's insurance be primary? We just got a recoupment EOB from the insurance we thought was primary. Thank you for your help.

Kar116

Hello,
"If the Custodial parents have primary custody of their children, with their home being where the children spend the most time, their policy is primary. HOWEVER, I currently have a situation right now with a claim from last year where the primary COB wasn't updated by Mom (w/ documented court order requiring bio-Dad's policy to be PRIMARY), until early this year. Therefore, primary sent a refund request letter stating they paid as primary in error, and step-Dad's policy is primary due to the birthday rule. This is not true, as a court order about children's health coverage after a divorce supersedes the birthday rule. Good luck and keep us posted!