beachalice

Secondary insurance policies

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Can anyone help explain how secondary insurance works with regard to surrogacy?

 

I know in the general healthcare world, a person could be covered by two policies. Maybe spouses both have coverage for each other through their workplaces or an adult child has limited benefits from work with full coverage under parents, etc.

In this case the PRIMARY coverage is always the employer's plan first. Then any secondary policy can help cover additional costs after deductibles are met. There can be significant financial consequences if the claims are submitted out of protocol.

 

In the world of surrogacy, some policies do not cover surrogate pregnancy costs - and some even go to the extent of threatening liens against compensation. How do secondary policies work in this instance? Do surrogates simply not mention their primary coverage? Are there any potential areas of concern?

 

With manadatory health insurance now, insurers are submitting proof of coverage (Form 1095) to the IRS. What happens when two companies submit their proof of coverage for a single patient? Can the insurance companies find out the Primary policy was not billed and cause grief for surrogates?

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Traci - do you know what the surrogates you with do about multiple policies?

How do surrogates use two different policies without indicating primary and secondary?

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I LITERALLY JUST sat through a teleconference this afternoon about this!! You can only have a "secondary" policy if your primary policy has no surrogacy exclusion or ambiguous wording. It would only be able to be used if the primary ended up denying a claim or if you had to go out of network. Then the secondary policy would be activated. If the primary policy has a surrogacy exclusion, then you would have to get a universal policy, a reimbursement (which works whether you have Tricare, cash pay, HMO/EPO and creates a stop-loss for the IP's. More flexible but $$$) policy or a bridge the gap policy which is very temporary.

 

Tricare and Kaiser specifically, are considered 2nd party payers and they consider the IP's as "primary" payer and will place liens on the compensation. In CA, they are maxed at 49% of the comp, but all other states do not have this limit. Kaiser is subjected to a limit of 2yrs that they can go back and rescind payments, however, Tricare has NO limit on how long they can come back after you. They can initially agree on what they consider to be "reasonable" expenses (for example, $8500) and then decide that it is no longer reasonable (say baby is in the NICU and costs are now $120+k) and come after you for additional funds.

 

For our surrogates, if they have an exclusion, we get them a primary policy and I contact the business office to make sure that they are aware of needing to bill this policy only, and then arrange payments for what is not covered by insurance. For myself and another current surrogate w/us, we had no exclusions. I did not accept a secondary policy because of my previous experience and our specific policy (along w/written statements from insurance that they WILL cover a surro-pg fully) but the other surro's IP's did put a secondary policy in place for her. The initial was about $2000, and unless they need to activate it for some reason, they won't pay more than that.

 

I did learn a little about the difference between self-funded plans and "trust & welfare" plans (never knew about the latter), which boils down to how they are administered. The trust & welfare fires a 3rd party to administer the claims and has a significantly higher rate of denials for things that are NOT exclusions either! There is a lot more legwork in trying to deal w/this type of plan, to get things covered as stated.

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Okay. So if a surrogate is covered by employer insurance and has an exclusion, is it best to NOT SIGN UP for the year with exclusion policy but rather be covered ONLY by marketplace plan - which is then paid for by the surrogate or IPs according to terms of contract?

 

Are universal or reimbursement policies on the marketplace?

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I believe she said the universal is, but not sure how to go about getting the reimbursement policy. I'll email them and ask.

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