Wiki Stepparents COB

[JVILLAS]

Hello

I have a patient. His stepmother and step father hold insurance for him. Neither bio parents provide insurance. Who would be primary? Must they have a custody agreement? If not would it be the stepparent who the patient lives with?

Any advice would be appreciated. I tried to research but could not find clarity.

Thank you

Jennifer

 

[amyjph]

I have never encountered this scenario, however I think you would still follow the birthday rule and might go by the subscriber's birth date. It might go like this though if there are custody issues, etc. :
If parents are divorced and there is a court order stating which parent is primary, then…The policy of the parent listed on the court order is the primary plan.
If parents are divorced and no court order, then…The parent with custody is the primary plan.
If parents are divorced and parent with custody remarried, then…The plan of the stepparent with custody is primary over the natural parent without custody.
If parents have joint custody, then…The primary plan is determined by birthday or gender rule.
If the dependent/child is an overage student and custody is no longer an issue, then…The parent the child resides with is the primary plan.

I googled the above and found here: https://www.psu.edu/news/campus-life/story/do-you-have-multiple-insurance-coverage-your-family/

You could check with each plan to see if they have info.

 

[JVILLAS]

That was a great explanation. Thank you I will definitely read what you sent!

Have a great day.

 

[csperoni]

I think in a complex scenario like this, I would ask whoever is bringing in the child for treatment which insurance is primary. As long as the benefits verification for the insurances aligns with what the guardian is telling you, I wouldn't worry about the rest.

 

[JVILLAS]

I just don’t want to deal with a denial or recoupment because we billed the wrong insurance.