Coordination of benefits

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This article contains information that is helpful for Headway clients. If you are a provider and have questions about secondary insurance, check out our article for providers "Seeing a client with secondary insurance".

 

 

What is secondary insurance and how is it different from primary?

It is possible to have more than one insurance plan active at the same time. In these cases, one is assigned to be the “primary” plan, and one will be assigned to be the “secondary” plan. The primary plan will be responsible for paying your claims first, and your secondary plan will help to cover the leftover amount.

 

Can I use secondary insurance coverage on Headway?

At this time, Headway is not able to submit claims to secondary insurances, as our systems are not currently configured to support them. Clients must enter only their primary insurance information for verification.

That said, you are welcome to submit to your secondary insurance plan for reimbursement off of the Headway platform. You will receive invoices via email after each session, and can reference and download them directly from your Headway account anytime for reimbursement purposes.

Typically, your insurance carriers and laws governing coordination of benefits will determine which of your plans is primary and which is secondary. Below, several situations are outlined in which primary and secondary plans are pre-determined. These reflect common scenarios, but clients are encouraged to talk with their plan to confirm which plan is primary and which is secondary.

If you are a subscriber on one policy AND are a dependent on a different policy:

Primary Secondary
This will be the insurance plan on which you are the subscriber.

If you are married and are are receiving benefits through your employer’s insurance plan AND your spouse’s insurance plan:

Primary Secondary
This will be your employer’s insurance plan.

If you are under 26 and receiving benefits through your parents’ insurance plan AND your school’s insurance plan:

Primary Secondary
This will be your school’s insurance plan.

If you are under 26 (with married parents) and are receiving benefits from both parents’ separate plans:

Primary Secondary
This will be the insurance plan of the parent whose birthday comes first in a calendar year.

  This is commonly known as the “birthday rule.”

If you are under 26 (with divorced parents) and are receiving benefits from both parents’ separate plans:

Primary Secondary
This will be the insurance plan of the parent with custody of the child (if joint custody, the “birthday rule” applies).

If you are married and are receiving benefits from both your spouse’s plan AND your parents’ plan:

Primary Secondary
This will be your spouse’s insurance plan.

If you have a commercial insurance plan AND Medicaid:

Primary Secondary
This will be your commercial insurance plan.

If you have multiple insurance plans, and are still unsure which is your primary, you can reach out directly to either of your insurance carriers for clarity.

 

How will Headway know if my plan is primary or secondary?

With the way our system currently works, we rely on insurance portals to pull client benefit information; our system will automatically set an insurance plan to “inactive” if there is a secondary flag on the coverage. Clients with “inactive” coverage will not be cleared for scheduling until their active, primary coverage has been entered.

If you believe that your insurance policy was incorrectly flagged as secondary, you can reach out to your insurance company (there’s usually a direct phone number on the back of your insurance card) to further inquire about this. You can say “My provider let me know there’s an issue with my coordination of benefits—could you let me know which of my plans is primary?” Headway cannot do this on your behalf.

Once you’ve confirmed that your coordination of benefits has been updated on the insurance carrier’s end, let us know via our contact form and we can refresh your account details on our end.

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