Help: Issue with Two Health Insurance Plans Listed As Primary

[BesselJames]

This is going to be a long story, but I will try to be as concise as possible.

In 2008 I changed jobs and employers (graduate research assistant to a real job). When changing jobs I elected to become a member of my new employer’s group health insurance. My former employer kept me on their insurance plan for the rest of 2008, and apparently continued my plan through the 2009 calendar year. This additional coverage was unknown to me. I did not pay for the 2009 health insurance coverage with my former employer, nor did I see or sign any paperwork indicating that I would be covered. At the same time I continued my health insurance plan with my current employer, as I thought this was my primary (and only) coverage.

Both insurance plans were with the same company, but in different divisions, and both were listed as primary. These divisions apparently do not (and won’t) communicate with each other at all. Some time in 2011 I received an Explanation of Benefits (EOB) from a laboratory test that I had in 2009. The company had already been paid by my current employers plan in 2009, so I thought it was odd that I received an EOB indicating further payment. Apparently the lab found the insurance plan that I had with my former employer and filed under that too. I am not sure exactly how they found it, but the insurnace company paid them twice (once under my current employer’s plan, and once under my former employer’s plan).

Given this, what is the best (easiest, least time consuming, with minimum cost) way to fix this problem?
(1) Is this a problem? (I assume it is)
(2) Is there a statue of limitations (state this occurred in is Maryland)
(3) Can you think of any ways in which I will have to pay any (more) money out of pocket?
(4) What is best approach to fix this?

I’ve spoken with the insurance “experts” in my current and former employers HR divisions and they were no help. I prefer to not get a lawyer as I don’t see that a large financial burden with out much benefit. I’m hoping there is a statue of limitations and I can ignore it....

Any help or advice with this would be appreciated.

 

[Josh]

I'm not sure if it's the way you phrased it or if you left out some information, but this should mostly (if not wholly) answer your question.

If you have two insurance plans, typically you're better off canceling the one and using the single plan. Considering this has already happened you can't go back in time and change that.
If the provider (lab) has received payment from the carrier on two plans, you should probably contact them and ask their billing office to adjust it.
You can also simply ignore everything as long as no one is asking you for money because at the end of the day it's really an issue between the carrier and the provider. For the sake of discussion let's say that you're lab work was covered 100% and that it cost $100. If you have two insurance coverages as you described they would usually coordinate benefits and one would pay half ($50 in this example) and the other would do the same, or some version of that behavior. One way to skirt that altogether is to simply only provide the provider with one set of insurance information, hence my first statement.

To answer your question in one sentence:
If no one is asking you for money, this is absolutely not your problem and it's something the carrier and the provider will need to work out.

Does that answer everything?

 

[somarco]

This appears to be an administrative error on the part of your former employer. Since you have contacted HR at your former employer, that should be it. You should be able to wash your hands and move on.

It appears you don't have any skin in the game. As they say in Jersey, fugedaboutit.

Your former employer is due a refund of premiums back to the last day you should have been covered, although the carrier may limit the refund to 12 months, less any claims paid.

 

[BesselJames]

Thanks for the reply. My concern is that both my insurances were listed as primary. So there was no coordination.

Using your $100 example in this case, my primary insurance plan #1 (current employer) only covered 50% of the bill ($50), my primary insurance plan #2 (former employer) covered 60% of the bill ($60). Thus the lab god paid more than they billed.

Are you sure having 2 health insurance plans listed as primary isn't fraud?

Is this like me submitting the same claim to two different insurers and lying about it be covered by another plan? I didn't initiate the claims, the lab did, but still...Maybe they are the ones committing fraud?

It is true that no one is asking me for money, but I also don't want anyone suing me....

I'm not sure if it's the way you phrased it or if you left out some information, but this should mostly (if not wholly) answer your question.

If you have two insurance plans, typically you're better off canceling the one and using the single plan. Considering this has already happened you can't go back in time and change that.
If the provider (lab) has received payment from the carrier on two plans, you should probably contact them and ask their billing office to adjust it.
You can also simply ignore everything as long as no one is asking you for money because at the end of the day it's really an issue between the carrier and the provider. For the sake of discussion let's say that you're lab work was covered 100% and that it cost $100. If you have two insurance coverages as you described they would usually coordinate benefits and one would pay half ($50 in this example) and the other would do the same, or some version of that behavior. One way to skirt that altogether is to simply only provide the provider with one set of insurance information, hence my first statement.

To answer your question in one sentence:
If no one is asking you for money, this is absolutely not your problem and it's something the carrier and the provider will need to work out.

Does that answer everything?

- - - - - - - - - - - - - - - - - -
My former employer doesn't seem to care, but I'm worried about the issue for the double pay out to the laboratory where both insurance plans acted as primary (without coordination) and the lab got overpaid. :(

This appears to be an administrative error on the part of your former employer. Since you have contacted HR at your former employer, that should be it. You should be able to wash your hands and move on.

It appears you don't have any skin in the game. As they say in Jersey, fugedaboutit.

Your former employer is due a refund of premiums back to the last day you should have been covered, although the carrier may limit the refund to 12 months, less any claims paid.

 

[somarco]

lab got overpaid

If the money was not refunded to you there is nothing to worry about.

Based on your comments, this is an issue between your employer and the carrier.

 

[BesselJames]

Thanks.

I might have gotten some money out of my FSA through my current employer's self-funded FSA because it was automatically processed by the health insurance company (didn't fill out form or sign anything to get money from the FSA). I'd have to check.

I did have enough other expenses to cover that much in my FSA for that year, but didn't file because it was taped out.

Does your response change based on this information?

If the money was not refunded to you there is nothing to worry about.

Based on your comments, this is an issue between your employer and the carrier.

 

[Jack_Merton]

Yes. I think you were just fortunate that the two plans overlapped. I don't think coverage from multiple companies is ever illegal, even if they're both listed as primary. The premiums would just be really expensive to maintain!

 

[junkman]

I think you were ineligible under your former plan. It also appears that your former employer dropped the ball by not sending a Cobra or State Continuation notice.

Responsibility for Cobra administration and terming coverage is your employer's. It is not your responsibility.

Plan 1 paid because the provider filed the claim and you were still showing as enrolled. Since it is a self-funded plan, it is to the employer's advantage to reverse the charges. They also are due some premium refund.

Plan 2 paid because the provider filed and because you were listed as enrolled. The provider had no business filing with both plans. The correct filing is with your current plan. The provider should know better but frequently have clerks that file with whatever carrier is listed without regard to being correct.

If it gets straightened out, your liability will be whatever it is supposed to be under the current plan. Claim filing and billing is not your responsibility either.

I would probably notify HR and let them deal with it or not as they choose. I would not put much time into it, perhaps only notify HR to make sure that you are off the plan.

If it turns out that you owe anything significant, make sure that the claim was filed and paid correctly then negotiate a 10 - 20% "prompt payment discount".

 

[BesselJames]

Thanks for the replies.

Cobra definitely wasn't in play since I started my new job the weekend after I ended my old one.

I'm not worried about owing the provider, because I payed them what they asked for and I received no pay out from either of my insurance companies.

I was more concerned with being sued for accidentally having 2 primary insurance companies, both of which paid for a single (and small) incident, but only paid out to the provider.

It sounds like I shouldn't worry.

I think you were ineligible under your former plan. It also appears that your former employer dropped the ball by not sending a Cobra or State Continuation notice.

If it turns out that you owe anything significant, make sure that the claim was filed and paid correctly then negotiate a 10 - 20% "prompt payment discount".

 

[shepnerd]

You're clean dude. No worries. Like they say, you can let the people know, but you didn't commit any fraud. Its an administrative error on your former employer, and you dont have any duty to make sure they cancel your insurance.

There is nothing illegal about having two insurance companies/plans covering the same loss, as long as you dont profit from the loss- its basically just an expensive way to not have a deductible.

Think about wrecking your car and your car insurance and health insurance working out who pays what. Like Josh said, they'll coordinate coverage. I get that the provider filed it wrong and got an extra $10, but that would never come back on you and the $10 isn't worth the time & trouble to fix.