求助：医疗保险的问题

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威望11

贴子9340

魅力17078

注册时间2013-10-18

okura

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2016-12-20 14:46:37

Bcbs没办法慎买啊那种好医院好大夫覆盖最多的就是他家

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威望90

贴子73077

魅力72759

注册时间2006-03-09

Ruth

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2016-12-20 14:49:02

就我所知，自己名下的是primary，通过配偶的，secondary。

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威望11

贴子9065

魅力12391

注册时间2008-10-18

cavity05

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2016-12-20 15:11:47

就我所知，自己名下的是primary，通过配偶的，secondary。
Ruth 发表于 12/20/2016 2:49:02 PM [url=http://forums.huaren.us/showtopic.aspx?topicid=2111337&postid=73639989#73639989]

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老实说，我也是这个理解

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威望1

贴子1297

魅力1840

注册时间2016-03-02

woyaomaifang

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2016-12-20 15:30:47

自己名下的优先成为primary。除非你的bcbs没有加cob provision（coordination of benefits). 不过bcbs大公司不太可能。。。。 Primary vs. Secondary Carrier The following rules apply when determining which health plan will be the primary payer: Any plan without a COB provision always pays first. If the person receiving benefits is the participant under the contract, that health plan will be primary. The spouse’s health plan will become secondary. If a dependent child is covered under two or more plans, the plan of the member covering the child whose birthday occurs earlier in the calendar year will be primary (known as the birthday rule). If both have the same birthday, the policy that has been in effect longer will be primary. The birthday rule is superseded when a court order or custody rule applies.

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威望1

贴子885

魅力903

注册时间2010-05-01

appleseed88

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2016-12-20 15:38:44

就我所知，自己名下的是primary，通过配偶的，secondary。
Ruth 发表于 12/20/2016 2:49:02 PM [url=http://forums.huaren.us/showtopic.aspx?topicid=2111337&postid=73639989#73639989]

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是这样的，我碰到过相同情况，保险公司就是按楼上所说付钱的。

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威望--

贴子165

魅力245

注册时间2013-05-23

田园土人

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2016-12-20 15:57:37

我有段时间也有两个保险，有个帐单现在还PENDING着，大家都不付。

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威望5

贴子4986

魅力9142

注册时间2009-10-13

fayfaytu

只看楼主

2016-12-20 16:08:53

自己名下的优先成为primary。除非你的bcbs没有加cob provision（coordination of benefits). 不过bcbs大公司不太可能。。。。
Primary vs. Secondary Carrier
The following rules apply when determining which health plan will be the primary payer:
Any plan without a COB provision always pays first.
If the person receiving benefits is the participant under the contract, that health plan will be primary. The spouse’s health plan will become secondary.
If a dependent child is covered under two or more plans, the plan of the member covering the child whose birthday occurs earlier in the calendar year will be primary (known as the birthday rule). If both have the same birthday, the policy that has been in effect longer will be primary. The birthday rule is superseded when a court order or custody rule applies.
woyaomaifang 发表于 12/20/2016 3:30:47 PM [url=http://forums.huaren.us/showtopic.aspx?topicid=2111337&postid=73640441#73640441]

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谢谢mm！不管谁是primary其实只要他们把账单付了就行，mm知道这种情况有什么办法监督么？如果aetna是primary的，那怎么催aetna付钱呢？他们找的理由是，自己是student health plan, is secondary to any other plan。。。

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威望5

贴子4986

魅力9142

注册时间2009-10-13

fayfaytu

只看楼主

2016-12-20 16:11:04

回复 [url=http://forums.huaren.us/showtopic.aspx?topicid=2111337&postid=73640730#73640730]16楼田园土人的帖子[/url] 那mm现在怎么办呢？我的账单很多，有2万多刀，不可能自己付了啊。。。保险这种东西追溯期是一年，如果过了一年，那岂不是都得自己付了？保险公司可以不管了？

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威望5

贴子4986

魅力9142

注册时间2009-10-13

fayfaytu

只看楼主

2016-12-20 16:14:46

没看懂bcbs的逻辑即使是secondary 那也要付款不能直接拒付啊不然所有事情都是要说自己是secondary就好了只管收钱不管交钱稳赚不赔的生意谁不会做啊有没有高人解释
chmod999 发表于 12/20/2016 2:40:12 PM [url=http://forums.huaren.us/showtopic.aspx?topicid=2111337&postid=73639894#73639894]

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对，所以我觉得aetna比bcbs靠谱，一aetna起码是pending,并没有直接拒付，二aetna还联系了我，给我解释了原因。bcbs直接就拒付，也不和我联系，超级无耻！就算他们是secondary的，起码也要像aetna那样pending吧，起码要给我寄eob来解释吧。。。不管付不付，eob不是基本要求么？