Show  Under an assignment of benefits, a payer can make payments directly to a policyholder. The birthday rule is used to determine which of two parents with medical coverage has the primary insurance for a child. A coordination of benefits clause is included in medical insurance policies to explain how the policy will pay if more than one policy applies to a claim. A nonparticipating provider must follow the plan's rules regarding fees for services. The insurance plan that pays benefits after the primary payer is referred to as secondary insurance. The medical insurance specialist verifies patients' insurance coverage by contacting their employers. The policyholder is always the patient. The superbill, charge slip, or routing slip are other terms for the patient information form. Medical offices cannot treat a patient who refuses to sign their Acknowledgment of Receipt of Notice of Privacy Practices. A patient may have coverage under more than one health plan. How does the office determine which parents coverage is primary?If your kids are covered under both parents' plans, there are some general guidelines that help determine which plan is primary and which is secondary. Primary coverage generally comes from the plan that belongs to the parent whose birthday comes first in the year.
How do you get around the birthday rule?The easiest way to avoid the birthday rule is to look at both health plans and decide which is the better choice. Then, move everyone to that plan and drop coverage with the other one.
Who is the primary on an insurance policy?A person who fills out and signs a request for insurance coverage is usually referred to as the primary insured or applicant. This person is generally the intended policyowner and is listed as applicant on the premium due page after a policy is issued.
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