Sign up, and you can customize which countdowns you see. Sign up
Jan 25, 2022
9:58:38am
robin All-American
Health Insurance rules in this country are asinine.
For most of my marriage I've been the only one employed, and my insurance covered everyone in the family. Over the past 10 years or so the insurance coverage has progressively gotten worse and more expensive on my end.

As our youngest entered school full time, my wife decided to get a job, making extra income that is mostly set aside for extra luxuries (nicer vacations, home upgrades, etc). Her company decided to offer health insurance, and the plan they offer her is significantly better than the coverage/cost that my plan has been, even though I work for a fortune 100 company. So I'm initially loving that now we should have much more affordable coverage between our 2 plans.

Theoretically having dual insurance plans should cost the insured significantly less than having just 1, but this is where the insurance rules in our country are crazy, and just plain backwards.

Basically there is this concept known as "coordination of benefits", where in theory if the main insurance doesn't cover something, then the secondary insurance should step up and also help cover some of the cost. But in reality, neither insurance wants to pay for anything. And they use this "coordination of benefits" to basically say "well, you are covered under that plan, so we are denying your claim".

There is a stupid, stupid rule in this concept of identifying which plan is the primary, and which one is the secondary. An insured should be able to just choose which insurance they want to have be billed first, based on which policy provides the best benefit. But they don't do it that way. The rule is, between spouses with full coverage, whichever spouse has the earlier birthday in the calendar year, has the primary plan, and the other spouse has the secondary plan. What nonsense is that? Why should when a Birthday falls in the year matter.

So in my situation, since my birthday is in January, and my wife's is in December, my insurance will always be considered the primary plan, and wife's will always be secondary.

So every claim that I would want covered under my wife's plan because it would cost me significantly less, gets denied, under the rule that it should be covered under my plan, the primary plan. But my plan sucks, and doesn't cover anything until I spend like $7000 out of pocket.

We would be better off if I had no insurance at all. That's how insane this process is. And even if I don't disclose to my wife's plan that I have a plan, they figure it out. There is some kind of national coordination of benefits system/website that all the insurance companies put their info in, and that tells them everyone's coverage under different plans. I think they do that so they can all deny the claims claiming someone else is responsible.

So now I am at the point where I am calling my employer, and requesting my children be removed from my insurance plan, just to try to get my wife's plan to cover them. But I can't just remove them from the health insurance, I have to remove them as dependents from all my benefit coverages. And they might not be able to do it because I'm outside the enrollments window. I've been on the phone with 6 different companies over the past 2 weeks probably like at least 10 hours trying to get this all straightened out.

I think the goal is that they make these processes so convoluted and difficult, that people just give up and decided to either pay for stuff with cash that should be covered by insurance, or just go without health services.
This message has been modified
Originally posted on Jan 25, 2022 at 9:58:38am
Message modified by robin on Jan 25, 2022 at 10:04:33am
Message modified by robin on Jan 25, 2022 at 10:06:55am
Message modified by robin on Jan 25, 2022 at 10:09:24am
robin
Bio page
robin
Joined
Apr 21, 2002
Last login
Apr 29, 2024
Total posts
4,280 (2 FO)
Messages
Author
Time

Posting on CougarBoard

In order to post, you will need to either sign up or log in.