Primary vs. Secondary Insurance Provider?

[ready123go]

I hope my statements and questions are clear. I would like to fully understand the process by which a primary carrier fulfills its function or obligation vs. the process by which a secondary carrier fulfills it function or obligation.

 

As I understand it, a secondary provider will not pay until a primary has denied a claim. No problem there. If a claim exceeds the maximum amount covered by the primary policy, a secondary will pay the outstanding balance (not including the deductible from the primary plan) up to their coverage limit. Makes sense.

 

Here the confusion sets in. I have read in some posts that primaries pay the service provider (i.e. medical facility) directly, while a secondary simply reimburses the costs incurred by an insured individual. Is that accurate? Additionally, I have read if there is no primary policy, then a secondary policy kicks in as if it were a primary. If so, how does this function? How does a secondary meet its obligation? Does the secondary insurer then pay service providers directly? I would assume they do not, but how does it work?

 

What are the pros and cons of both primary and secondary insurers?

[cherylandtk]

In travel insurance, I am unaware of any policies, primary or secondary, that generally pay the provider directly, except perhaps for some cruiseline issued plans that pay the ship doctor fees, but not always in all situations. (Unlike major medical policies which often do pay the provider directly.) In most cases, you must pay the bill first and then be re-imbursed.

 

In really difficult and expensive cases, it is sometimes possible to negotiate that directly with the insurance company, however this would be handled on a case-by-case basis with primary insurance. Secondary insurance still would first require handling by your primary insurance.

 

As for a secondary kicking in as primary, it would depend on the insurance plan used, and the structure of the claim form, but IIRC, there is just a box you check that says you do not have any other insurance. If you do have other insurance, it will ask for the EOB from that insurance.

 

If you had a) a really expensive and serious case and b) a secondary policy and c) no other primary insurance THEN you might have to work extra hard to convince the insurance company to pay the provider directly.

[sirwired]

A Primary vs. Secondary policy is very simple; a secondary policy pays out whatever primary insurance does not cover. Some secondary policies require you to have primary coverage, some don't.

 

All travel insurance ordinarily pays you and not the provider. If you haven't yet paid the provider, you then turn around and do so with the check they cut you. I suppose there might be circumstances where they might mail the check directly to the provider, but that would be very non-routine.

 

I've read the same posts you have about primary insurers paying directly to the provider; it's simply not true for most travel insurance policies. That would require pre-arrangement between the insurer and provider, and if you look at travel insurance, you will find that there aren't any provider networks, nor does the part of the policy with claim instructions say anything about it.

 

I imagine that annual travel medical policies might do this, but the one-off policies you are probably interested in purchasing don't.

 

Don't take my word for it... read any policy yourself, in its entirety, before purchase.

 

SirWired

[Keith1010]

We obtain travel insurance where they act as the primary carrier. That way we don't have to first file with our regular medical insurance carrier.

 

Our experience has always been that when we use the travel insurance we pay the bills first for the medical services. We then file a claim with the travel insurance company filling in the paperwork exactly as it requests and attaching the bills (the company we uses wants originals) and then we file the claim with this company. Since they are the primary they do not have to followup with our regular insurance company. The benefit to all of this is speed and simplicity.

 

Keith

[cruiseco]

If you're worried about not having the funds to either be admitted to a foreign hospital or to pay the bill to be discharged, many plans will help you there. And being "primary" or "secondary" doesn't really seem to matter.

 

For example, this is from TravelSafe, a secondary insurer:

 

"Emergency Medical Payments - We will assist you in the advancement of funds or guarantee payments (up to the policy limits) to a hospital or other medical provider, if required, to secure your admission, treatment or discharge." The policy limit in this case is $100,000.

 

Here's from a Travelex plan, a primary insurer:

 

"The Company will advance payment to a Hospital, up to the maximum shown on the Confirmation of Coverage, if needed to secure Your admission to a Hospital because of an Accidental Injury or Sickness." The policy maximum for this plan is $50,000.

 

In both cases the idea is to get you in the hospital and get you out of the hospital and worry about the paperwork later.

 

One reason why any primary insurer is reluctant to direct-pay a doctor/hospital is that with travel insurance policies there are so many exclusions that don't exist in a regular medical policy. For example, if you fall down a flight of stairs at a hotel because you're dead drunk your regular medical plan is still going to pay to get your broken arm re-set. But your travel insurance policy probably has an exclusions for accidents caused by being intoxicated. If they paid the hospital that treated you directly and then, when the police report is submitted a month later, find out that you aren't covered they've got a problem on their hands.

[ready123go]

Thanks to all who responded.