While health is primary, there are things that are called secondary in health care to include secondary health providers and secondary health insurance. In today’s complicated medical environment, it is important to understand them and know how they should be utilized.
Secondary health providers
Those who provide secondary care are usually specialists who do not see patients unless they have been referred to them by their primary care providers. Examples of these types of providers include cardiologists and dermatologists. These physicians limit their practice in this way either under their own accord or because of payment agreements with insurance providers. Patients who are referred to these secondary health providers by physicians apart from their primary care providers need to insure their health plan covers it.
Secondary health insurance
In some situations, such as those who have two jobs or with married couples and dependents, it is possible to be covered under two plans. This is referred to as having secondary health insurance. There are various rules that apply so anyone who qualifies needs to understand them.
For those covered under two plans, the first step is to figure out which will serve as primary coverage. This is done by the insurers involved. If one is employed, the insurance offered by their own employer will generally be their primary coverage. The criteria used will depend on the types of health insurance and the final decision will rest with the insurance companies.
Both spouses having health insurance does not automatically mean they have secondary coverage. If one spouse has individual health insurance that does not insure others, the coverage will not extend to the other spouse in any way. Since having plans that cover more people is certain to cost more, those using secondary insurance need to consider if the benefits are worth the added expense.
Advantages of secondary health insurance
In some cases, the secondary plan may cover services the primary plan does not. This could be paying for a higher percentage of the care or for services the primary care does not. It also can be used in cases of very serious illness or injury when the benefits from the primary insurer have been depleted. It is necessary to check with the certificate of coverage to see what the benefits are.
Using secondary care
If extra benefits are available from the secondary insurer, the health care provider can bill them once the standard benefits have been received from the primary insurer. However, any health insurance deductibles or other fees from the secondary provider will still be applicable and must be paid. Also, only remaining costs that have not been paid by the primary insurer can be billed.
Words of caution
Apart from considering if the costs are worth it, one should be very careful to be upfront with the insurance providers to avoid any problems collecting. It is also paramount to keep careful records to avoid unwanted surprises. Finally, be sure the healthcare providers are informed of the primary and secondary coverage.
