Secondary insurance and coordination of benefits

Updated

If you have more than one insurance plan active at the same time, one is assigned to be the “primary” plan, and one is 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 any leftover amount.

Typically, your insurance carriers and laws governing coordination of benefits will determine which plan is primary and which is secondary.

Don't know which of your insurance plans is primary? Below, several situations are outlined in which primary and secondary plans are pre-determined. We also encourage you to talk with your 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
The plan on which you are the subscriber. The plan on which you are a dependent.

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. This will be your spouse’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. This will be your parent’s insurance plan.

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

  This is commonly known as the “birthday rule.”

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

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). This will be the insurance plan of the parent who does not have custody (or “birthday rule” if not applicable).

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. This will be your parent's insurance plan.

If you have a commercial insurance plan AND Medicaid:

Primary Secondary
This will be your commercial insurance plan. This will be your Medicaid 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 Headway determines whether a plan is primary or secondary

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 to further inquire about this. 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.

 

Resolving coordination of benefits issues

Clients have to recertify their coordination of benefits (COB) yearly and are the only ones who can do this, providers cannot do this on behalf of a client. The most direct way to update or confirm your COB is to call the insurance number on the back of your ID card.

  Pro tip: Utilize your insurance company's app! If your insurer offers a mobile app, this information is there and they can help you out– often with no call required.

Paused accounts

If your account has been paused, it's because your insurance plan let us know that there’s an issue with your coordination of benefits. You will not be able to continue sessions until this has been resolved.

Resolving a paused account

To unpause your account we'll need the following from you: 

  • Ensure details entered on headway.co are reflective of your primary insurance.
    • Not sure which is your primary plan? Call the claims number on the back of your insurance card to ask.
      Here’s what to say:
      • “Is this my primary insurance? Why do I have a claim pending or denied, and how can I fix it?” 
        • They may ask for your date of service, which you can find on your Appointments page.
        • If they tell you nothing is pending and you’re all set, ask, “When was the coordination of benefits last updated? Can all pending or denied claims be reprocessed normally”
          • If your Coordination of Benefits is updated, get your call reference number from the agent..
          • If your Coordination of Benefits is not updated, ask what needs to happen next. You may need to update your information, but they should provide the steps. From there, future claims should be processed without issue.
          • Before hanging up, get your call reference number from the agent.

Once you've completed the above, reach out to us with your reference number(s) once you’ve completed these calls.

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