Get insurance coverage for child through both parents’ plans to help cover therapy?

[Anonymous]

It’s clear we’ll be doing a ton of therapy next year for our DS. My spouse and I are both feds so the insurance is pretty good.

DS will likely be in at least 3 therapy sessions/week (OT, PT). It looks like most of the coverage offers 60 sessions/year. So if we both cover him, that’s 120 sessions, right?

Has anyone done this? I’ll obviously have to run the numbers, but at first glance it’s looking like a very good idea.

Anyone know something I’m not thinking about?

Thanks!

[Anonymous]

What you need to look at is the joint coverage provisions of the policies. Depending on the policies, you could have double the amount of coverage. Or you could have only the amount of the higher of the two policies. Coordination of coverage provisions are complicated. They can eliminate ate all of the benefits of double coverage, which would mean you still pay the same OOP but pay for an extra insurance policy.

I am an attorney who advised and litigated on this issue often. Know the policies you are buying. When it looks too good to be true, it probably is.

[Anonymous]

PP is so right. I've had double coverage from time to time, and it's amazing how the insurance works to minimize their payout. Therapies such as those you mention seem to be a particular target.

[Anonymous]

Anonymous wrote:What you need to look at is the joint coverage provisions of the policies. Depending on the policies, you could have double the amount of coverage. Or you could have only the amount of the higher of the two policies. Coordination of coverage provisions are complicated. They can eliminate ate all of the benefits of double coverage, which would mean you still pay the same OOP but pay for an extra insurance policy.

I am an attorney who advised and litigated on this issue often. Know the policies you are buying. When it looks too good to be true, it probably is.

So, to clarify, I think you are talking about the number of visits, not the amount of reimbursement, right? Because even if you have joint coverage, you would still have to show that 120 PT visits/year were medically necessary.

For the actual costs of medically necessary care, I don't see how a secondary health insurance policy could just refuse to pay anything unreimbursed from the first policy. How would that make any sense?

An of course, another issue is all the paperwork. I assume this is out of network so OP will have to be submitted 2 claims for each visit. Total PITA even if you combine a bunch of visits on one claim form.

[Anonymous]

Anonymous wrote:

Anonymous wrote:What you need to look at is the joint coverage provisions of the policies. Depending on the policies, you could have double the amount of coverage. Or you could have only the amount of the higher of the two policies. Coordination of coverage provisions are complicated. They can eliminate ate all of the benefits of double coverage, which would mean you still pay the same OOP but pay for an extra insurance policy.

I am an attorney who advised and litigated on this issue often. Know the policies you are buying. When it looks too good to be true, it probably is.

So, to clarify, I think you are talking about the number of visits, not the amount of reimbursement, right? Because even if you have joint coverage, you would still have to show that 120 PT visits/year were medically necessary.

For the actual costs of medically necessary care, I don't see how a secondary health insurance policy could just refuse to pay anything unreimbursed from the first policy. How would that make any sense?

An of course, another issue is all the paperwork. I assume this is out of network so OP will have to be submitted 2 claims for each visit. Total PITA even if you combine a bunch of visits on one claim form.

I am talking about both. You can’t make generalizations. You have to read both policies.

[Anonymous]

OP here. This is very helpful.

I don’t think establishing medical necessity will be a problem (OT, PT, speech therapy for a toddler). He will have multiple appointments a week and we’ll wipe out the 60 visits in no time.

What’s the best way for me (someone who tries, but really doesn’t understand health insurance) to figure out what the best approach is as we head into open season when my spouse and I can select new coverage?

[Anonymous]

I don't think you can carry two federal plans on the same people simultaneously. When I was divorcing and we were removing my ex from my insurance to his own (also federal) plan the paperwork got messed up and they cancelled my insurance midway through the year due to dual enrollment. It was a total hassle to figure out

[Anonymous]

Anonymous wrote:I don't think you can carry two federal plans on the same people simultaneously. When I was divorcing and we were removing my ex from my insurance to his own (also federal) plan the paperwork got messed up and they cancelled my insurance midway through the year due to dual enrollment. It was a total hassle to figure out

Thanks so much for this. I’ll dig into it.

[Anonymous]

Anonymous wrote:OP here. This is very helpful.

I don’t think establishing medical necessity will be a problem (OT, PT, speech therapy for a toddler). He will have multiple appointments a week and we’ll wipe out the 60 visits in no time.

What’s the best way for me (someone who tries, but really doesn’t understand health insurance) to figure out what the best approach is as we head into open season when my spouse and I can select new coverage?

The terminology to use when asking questions is “coordination of benefits”. You want to find out which policy will be primary and what additional will be covered by the secondary carrier.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I don't think you can carry two federal plans on the same people simultaneously. When I was divorcing and we were removing my ex from my insurance to his own (also federal) plan the paperwork got messed up and they cancelled my insurance midway through the year due to dual enrollment. It was a total hassle to figure out

Thanks so much for this. I’ll dig into it.

I think this is accurate.

Does anyone know which federal insurance plan offers the best coverage for tons of out of network PT, OT, etc?

Thanks!

[Anonymous]

I am fed as is exdh and I don't think anyone (like your dc) can be enrolled on two federal plans at one time.

[Anonymous]

I don’t recommend this.

We had our toddler double-insured for a few months and it became a bureaucratic nightmare with both companies not paying on legitimate, simple claims, despite our having done coordination of benefits. We are still fighting claims from 1.5 years ago.

[Anonymous]

The FSA may help a bit. It's taken out pre-tax and you can deduct it from your income. Still have to do reimbursements though.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I don't think you can carry two federal plans on the same people simultaneously. When I was divorcing and we were removing my ex from my insurance to his own (also federal) plan the paperwork got messed up and they cancelled my insurance midway through the year due to dual enrollment. It was a total hassle to figure out

Thanks so much for this. I’ll dig into it.

I think this is accurate.

Does anyone know which federal insurance plan offers the best coverage for tons of out of network PT, OT, etc?

Thanks!

I’m trying to figure this out, too. We have BCBS standard, but wondering if GEHA is better? Looking to max reimbursement for out of network coverage.

[Anonymous]

You should both max out the FSA