Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I notice that some providers seem to list the responsible party for a medical bill based on who is the primary name on the insurance even if the one treated is over the age of 17. Legally if the one treated is 18 or over they are responsible for co-pays over and above what the insurance covered. Are providers un-aware of that fact?
Last edited by jazzy jeff; 11-08-2014 at 06:26 PM..
I notice that some providers seem to list the responsible party for a medical bill based on who is the primary name on the insurance even if the one treated is over the age of 17. Legally if the one treated is 18 or over they are responsible for co-pays over and above what the insurance covered. Are providers un-aware of that fact?
Not if they sought services under the primary insured person's plan. That is something the primary insured agreed to when they signed up for the coverage. Additionally, many state insurance regulations allowes the practice. You are free to get your own insurance and use it which relieves the primary insured from responsibility, or you can simply be a cash payer.
Not if they sought services under the primary insured person's plan. That is something the primary insured agreed to when they signed up for the coverage. Additionally, many state insurance regulations allowes the practice. You are free to get your own insurance and use it which relieves the primary insured from responsibility, or you can simply be a cash payer.
I think you mis-understood my point. Has nothing to do with the insurance carrier. I am talking about the medical provider. The insurance company pays the claim. If the person that received the care is over the age of 17, they are legally responsible for what ever deductibles or co-pays that exist after that. However some care providers tend to bill the parent who is covering the young adult, which is wrong.
It has everything to do with the insurance carrier!
The primary insured has a CONTRACT with the health insurance company. The medical providers are under CONTRACT with the health insurance company. Part of those contracts allows any medical provider who is accepting that insurance to hold the primary insured financially responsible for any and all financial obligations incurred by any listed dependent.
So long as a person is using the benefits from the insurance plan, they are under the rules of the medical plan. The fact that 99% of the primary insured never read the policy doesn't mean they are not held responsible for the terms and conditions.
The doc office doesn't care who pays as long as it's paid. The "primary insurance carrier" is usually listed as the payer.
As for if a parent or kid pays co-pays, etc, i believe it is legally up to the state but most of the time, the 18+ child is responsible.
An 18 year old would usually be the responsible payer if uninsured.
There are exceptions of course. Situationaly dependent.
Co-pays and deductibles are what I was referring to in my original post. From everything I have read, it seems as though the only way a medical provider could hold a parent responsible for a dependent that is no longer considered a minor by state law is if a "guarantor agreement" was signed.
As far as Rabrrita's comment about the primary insured agreements with the insurance carrier. I for example have my insurance through an employer and was never presented any terms of the contract, nor did I ever sign any papers to obtain the insurance. But I plan on calling my insurer on the issue to see if there is such an agreement concerning who is responsible.
I have 3 dependents over the age of 17 on my policy and sometimes get bills listing me as the responsible party and sometimes not. My 21 year old going through maternity, I never received one bill in my name through any of the associated providers.
It has everything to do with the insurance carrier!
The primary insured has a CONTRACT with the health insurance company. The medical providers are under CONTRACT with the health insurance company. Part of those contracts allows any medical provider who is accepting that insurance to hold the primary insured financially responsible for any and all financial obligations incurred by any listed dependent.
So long as a person is using the benefits from the insurance plan, they are under the rules of the medical plan. The fact that 99% of the primary insured never read the policy doesn't mean they are not held responsible for the terms and conditions.
It is interesting in talking to friends about the subject as to who is responsible and the difference of opinions. Anyways just got off the phone with my insurance carrier and they told me pertaining to their contracts between providers in the cases where there is not an automatic co-pay for the visit.
The provider is not permitted to ask for pre-payment or bill for services until after the insurance pays. However the provider does have the right to ask the primary insured to sign a promissory and can refuse the service if not.
Of course this would not apply to any type of emergency service at a hospital or urgent care clinic. The patient again would be responsible.
From everything I have read, it seems as though the only way a medical provider could hold a parent responsible for a dependent that is no longer considered a minor by state law is if a "guarantor agreement" was signed.
Does not apply if the contract (under both state insurance law and commerical code) allows otherwise.
Quote:
Originally Posted by jazzy jeff
I for example have my insurance through an employer and was never presented any terms of the contract, nor did I ever sign any papers to obtain the insurance.
You did. I don't know of a single state in the US that will allow a primary insured to obtain health insurance without their approval. In addition, it's illegal to deduct monies (other than taxes and regulatory monies) from earned wages without the written approval of the employee. You may not remember signing, you may not even read what you signed, and you may have been signing all sorts of employer papers without knowing what they were, but you did absolutely signed the papers.
As for not having a copy of the plan, it's terms & conditions, have you ever asked the employer for a copy?
Quote:
Originally Posted by jazzy jeff
The provider is not permitted to ask for pre-payment or bill for services until after the insurance pays. However the provider does have the right to ask the primary insured to sign a promissory and can refuse the service if not.
It's standard practice for a provider to have to wait for the EOB to determine what is owed other than the 'co-pay'. Thats mainly because the actual contract price is the only price that determins provider pay. Their contract with the insurance company only lets them collect based on the contract price.
In addition the provider has to wait to see if any of the contracted price falls within the deductable. The provide can get an estimate by calling the insurance company and they will be told generally how much that procedure is contracted for and what portion will be the insured's responsibility, BUT, that all depends on submitted claims. So, a person who has $500 left on the deductable when called may have $0 remaining if new claims are processed before the estimated one.
Now, it's important to know that the health plan by the employer is ownerd by the company, not the employee. It's the employer who makes key decissions regarding the plans benefits and administrative processes.
As part of my employees plan, it states that the primary insured is responsible for any and all claims submitted by their authorized dependent they listed. When they signed for the insurance they were also agreeing to that provision. This makes the policy very atractive to providers who will be more willing to contract for that plan because they have that authorization in advance. Many employer plans have that provision. Even individual policies may have similar wording. If you read a BCBS individual application in mnay states, you see right on the application that by listing and covering additional individuals (dependents) you the primary insured agrees to be responsible for all financial obligations for those dependents. Once again, some may not read it and understand it, but once they sign, they are responsible.
I notice that some providers seem to list the responsible party for a medical bill based on who is the primary name on the insurance even if the one treated is over the age of 17. Legally if the one treated is 18 or over they are responsible for co-pays over and above what the insurance covered. Are providers un-aware of that fact?
I've never seen that. They always have a separate blank that says, "Responsible party (if not the primary insured)" or something like that. Also, the receptionist has always asked me for my ID and asked me if I am the primary insured. And I see the doctor just about every month.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
