Understanding health insurance can sometimes feel confusing, especially when you have more than one insurance plan. If you have two health insurance policies, you may wonder which plan pays first, what happens to the remaining balance, and how your coverage applies to mental health services.
At Positive Start Counseling Services, Inc., we understand that navigating insurance benefits can be an important part of accessing therapy and behavioral health services. Learning the difference between primary and secondary insurance can help you better understand how your benefits may work when receiving counseling services.
What Is Primary Health Insurance?
Your primary insurance is generally the health insurance plan that is responsible for processing a medical or behavioral health claim first.
If you have two health insurance plans, the primary plan typically receives the claim before the secondary plan. The primary insurance company reviews the claim according to its benefits and determines how much it will pay and whether there is a remaining patient responsibility.
For example, if you receive an eligible mental health service, your provider may submit the claim to your primary insurance company first. The insurance company then processes the claim according to your plan’s coverage, deductible, copayment, coinsurance, and other applicable requirements.
What Is Secondary Health Insurance?
Secondary insurance is another health insurance plan that may help cover certain costs remaining after the primary insurance plan processes a claim.
After the primary insurance company processes the claim, information about the claim may be sent to the secondary insurance company. Depending on the benefits provided by the secondary plan, the secondary insurer may pay some or all of an eligible remaining balance.
Having secondary insurance does not necessarily mean that every remaining charge will be covered. Each insurance plan has its own rules, exclusions, limitations, deductibles, copayments, and coinsurance requirements.
How Do Primary and Secondary Insurance Work Together?
When someone has two health insurance plans, the process may generally look like this:
- You receive a covered service.
- The provider submits the claim to the primary insurance company.
- The primary insurance processes the claim.
- The primary insurer determines its payment and any applicable patient responsibility.
- The claim information may then be submitted to the secondary insurance company.
- The secondary insurer reviews the claim according to its own benefits.
- Any remaining eligible amount is handled according to the secondary plan’s rules.
This process is often referred to as coordination of benefits (COB).
Because every insurance plan is different, the exact process and amount paid can vary.
Why Is Coordination of Benefits Important?
When you have more than one insurance policy, your insurance companies need accurate information about your coverage.
Coordination of benefits helps insurance companies determine which plan should process a claim first and how the other plan should handle the claim afterward.
If your insurance information changes, it’s important to notify your healthcare provider and your insurance companies. Keeping your coverage information current can help reduce delays in claim processing.
Can You Have Two Health Insurance Plans?
Yes. Some individuals may have coverage through more than one insurance plan.
For example, a person may have:
- Insurance through their own employer and coverage through a spouse
- Coverage through two eligible family plans
- A commercial health insurance plan along with another form of coverage
- Other circumstances in which multiple insurance policies apply
Having two plans doesn’t automatically mean that all healthcare costs will be paid. The plans must coordinate according to applicable insurance rules and the terms of each policy.
Which Insurance Is Primary?
Determining which insurance is primary can depend on your individual circumstances and the type of coverage you have.
For example, the order of benefits may be affected by factors such as:
- Whether coverage is through your employer or a spouse’s employer
- Whether you are covered as the subscriber or a dependent
- The specific insurance policies involved
- Medicare, Medicaid, or other government coverage
- Applicable coordination-of-benefits rules
Because these situations can vary, it is important to contact your insurance company when you’re unsure which plan is primary.
Your insurance carrier can provide specific information about your coverage and the order in which your plans should be billed.
What Does This Mean for Therapy and Counseling Services?
Primary and secondary insurance can apply to behavioral health services just as they can apply to other covered healthcare services.
When receiving counseling or psychotherapy, your insurance benefits may determine:
- Whether your plan covers the service
- Whether the provider is in-network
- Your copayment
- Your deductible
- Your coinsurance
- Whether prior authorization is required
- Whether there are limitations on certain services
- How claims are processed when you have secondary coverage
Mental health benefits vary significantly between insurance plans. Having insurance does not necessarily guarantee that a particular counseling service will be covered.
What Should You Do If You Have Two Insurance Plans?
If you have primary and secondary insurance, providing accurate information to your healthcare provider can help with the billing process.
Before beginning therapy, consider taking the following steps:
1. Provide Both Insurance Cards
Make sure your counseling provider has current information for both your primary and secondary insurance plans.
2. Confirm Your Benefits
Contact your insurance companies to ask about your behavioral health benefits, including coverage for outpatient psychotherapy and counseling.
3. Ask About Your Deductible
Find out whether you have met your deductible and how your deductible may apply to mental health services.
4. Ask About Copays and Coinsurance
Your insurance company can explain whether you have a copayment or coinsurance for covered behavioral health services.
5. Confirm Network Status
Ask whether your therapist or counseling practice is considered in-network with your insurance plan.
6. Keep Your Information Updated
Notify your provider and insurance companies if your coverage changes, your policy ends, or you receive a new insurance card.
What If My Secondary Insurance Doesn’t Pay?
It’s important to understand that secondary insurance does not automatically pay every balance left by your primary insurance.
The secondary plan will review the claim according to its own policy. Depending on the circumstances, there may still be an amount that is your responsibility.
If you receive a statement that you don’t understand, you can contact your insurance company and ask for an explanation of benefits (EOB). Your provider’s billing department may also be able to help you understand how the claim was processed.
Understanding Your Explanation of Benefits
An Explanation of Benefits, commonly called an EOB, is a document from your insurance company explaining how a claim was processed.
An EOB may show:
- The amount billed by the provider
- The amount your insurance considers allowable
- The amount paid by the insurance company
- Deductible amounts
- Copayments or coinsurance
- Amounts that may remain your responsibility
An EOB is generally not a bill. If you receive a bill from your healthcare provider, compare it with your EOB and contact the provider or insurance company if something doesn’t appear correct.
Positive Start Counseling Services, Inc. and Insurance
At Positive Start Counseling Services, Inc., we understand that insurance questions can be overwhelming when you’re already taking an important step toward improving your mental health.
Our team can help you understand the information needed for the billing process and work with your insurance information when applicable. However, insurance companies—not the counseling practice—determine your eligibility, benefits, coverage, and patient responsibility.
Because insurance benefits can change, we recommend contacting your insurance carrier directly to confirm your current mental health benefits and coverage.
Frequently Asked Questions About Primary and Secondary Insurance
Does secondary insurance pay after primary insurance?
Generally, the primary plan processes the claim first, and the secondary plan may then consider eligible remaining amounts according to its own benefits and coordination-of-benefits rules.
Do I need to provide both insurance cards?
If you have two active insurance plans, providing current information for both plans can help your healthcare provider submit claims correctly.
Does having secondary insurance mean I won’t have a copay?
Not necessarily. Your responsibility depends on the specific benefits and rules of both insurance plans.
Can I choose which insurance is primary?
Not always. The order in which insurance plans pay is generally determined by the applicable coordination-of-benefits rules and the circumstances surrounding your coverage.
Will my secondary insurance cover everything my primary insurance doesn’t?
Not necessarily. Secondary insurance processes claims according to its own plan benefits, exclusions, limitations, and coordination-of-benefits rules.
Who should I contact if I don’t know which insurance is primary?
Your insurance companies are the best source for determining your coverage order. You can also provide both insurance cards to your healthcare provider and let the billing team know that you have multiple plans.
Take the Next Step Toward Mental Health Support
Understanding your insurance coverage can make the process of beginning therapy feel less overwhelming. If you have questions about your behavioral health benefits, start by contacting your insurance company and asking specifically about outpatient mental health and psychotherapy coverage.
If you’re looking for counseling and mental health services in Palm Beach County, Positive Start Counseling Services, Inc. is here to help you learn more about available services and the process of getting started.
Contact Positive Start Counseling Services, Inc. to learn more about counseling services and take your next step toward a positive start.
Insurance coverage, benefits, deductibles, copayments, coinsurance, and coordination-of-benefits rules vary by plan and individual circumstances. Information in this article is for general educational purposes and is not a guarantee of insurance coverage or payment. Please contact your insurance carrier for specific information about your benefits and financial responsibility.
