Discussion 1- Medical Insurance Billing and Coding

The Discussion Scenario

The Discussion can be found in the interactive module.

A phone call came into the help center from an older patient. She asks, “Which of my insurances is my primary insurance?”

She has been on her husband’s HMO for a long time. Recently she got a new job that offers health insurance, as well.


What advice would you give the caller to find out how to tell which insurance would be her primary and why that matters. And, if she submitted a claim, should it be filed with multiple carriers?

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Expert Solution Preview

When it comes to healthcare, understanding insurance coverage can be complex. It is important for patients to know which insurance is considered their primary insurance to avoid confusion and ensure they receive the maximum benefits available to them. As a healthcare professional, it is essential to provide patients with clear and concise information to ensure they are making informed decisions.

To the patient who called the help center, I would advise her to contact both insurance companies and inquire which policy is her primary insurance. This information can also be found on the insurance cards or policy documents she has. The primary insurance is responsible for covering medical expenses before any other policy. It is important to know which insurance is primary because, if the patient submits a claim to the wrong insurance company, it may result in delayed payments, denied claims, or out-of-pocket expenses.

If the patient has both insurances and the primary insurance does not cover all the medical expenses, she can submit the claim to the secondary insurance. But, before participating in dual coverage, it is important to understand the coordination of benefits, deductible, or co-payments required by the insurance companies. Dual coverage is beneficial when the individual needs treatments that are above the primary coverage limits. In this scenario, the patient would submit the claim to the secondary insurance to cover the remaining cost of treatment.

In conclusion, it is essential for patients to determine which insurance policy is the primary policy to ensure they receive the maximum coverage available for their medical expenses. As a healthcare professional, we should provide patients with clear information on how to identify their primary insurance policy and the consequences of submitting claims to the wrong insurance company. We should also emphasize the importance of understanding the coordination of benefits and dual coverage to avoid any discrepancies or out of pocket expenses.

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