Coordination of Benefits

How do primary and secondary insurance policies work together?

It is possible to have more than one insurance policy at one time. In that case, your primary insurance policy would pay your claims first and then any remaining balance would be transferred to the secondary policy for processing.

As an example, someone might have Aetna as their primary insurance through their employer and United as their secondary insurance through their spouse. 

What is coordination of benefits?

Coordination of benefits is the process of determining which of your policies will serve as the primary and secondary insurance.

Does KEGE accept secondary insurance?

KEGE does not currently process secondary insurance. As a result, we ask that you only provide us with insurance information from your active, primary policy. If you submit details for a secondary insurance policy, your claims will be denied by the insurance company. You will be responsible for each session at out-of-pocket rates as determined by your provider unless you are able to provide us with correct, primary insurance information.

How does an insurance company determine primary and secondary insurance?

As a general rule, insurance companies will follow the guidelines listed in the table below when determining primary and secondary insurance:

Examples

You’re under 26 and covered by your school or employer’s plan and your parents’ health plan.

Primary

School- or employer-sponsored coverage

Secondary

Parents’ coverage

Examples

You’re married and you and your partner have insurance coverage through your respective employers.

Primary

Your employer’s coverage

Secondary

Your spouse’s employer coverage

Examples

You’re under 26 with married parents and both parents cover you under their separate policies.

Primary

The parent whose birthday is first in a calendar year (also known as the birthday rule)

Secondary

The parent whose birthday comes second in a calendar year

Examples

You’re under 26 with divorced parents and both parents cover you under their separate policies.

Primary

The parent with custody of the child. If parents have joint custody, the birthday rule applies

Secondary

The parent who doesn’t have custody, if applicable, or the parent whose birthday comes second in a calendar year

Examples

You’re under 26, married, and covered by both your spouse’s plan and your parents’ plan.

Primary

Spouse’s coverage

Secondary

Parents’ coverage

What happens if my insurance company encounters an issue regarding my coordination of benefits?

If KEGE receives a notice that there is an issue with your coordination of benefits (primary vs secondary insurance), our team will ask you to contact your insurance company directly and will provide step-by-step guidance.  We’ll ask you to notify us of the outcome via email after you’ve clarified your coordination of benefits information with the insurance company. 

One week after we send you the initial email notification, we will follow up with your insurance company to confirm one of the following:

• That the policy you provided is your primary insurance, and the insurance company incorrectly denied the claim(s)
• That the policy you provided is indeed your secondary insurance, and the insurance company correctly denied the claim(s)

What happens if KEGE confirms that the policy is my primary insurance?

We will submit all affected claims for reprocessing. No further action is required from you. 

What happens if KEGE confirms that the policy is my secondary insurance?

Unfortunately, secondary insurance policies are not accepted through KEGE’s insurance program at this time. If you are unable to provide us with your primary insurance information or if your primary insurance is not covered through KEGE, here is what you can expect:

• You will need to use the self-pay option for all visits

How can coordination of benefits issues be prevented?

In order to avoid a coordination of benefits denial, you should confirm that the insurance information you submitted to KEGE is from a primary, active policy. Should you fall into one of the situational categories listed in the table above, we recommend speaking with your insurance company directly. 

Billing Partner

KEGE Center for ADHD works with a billing partner called Alma to manage medical insurance billing. Alma specializes in handling insurance billing matters, including copayments and coinsurance, on our behalf. They are a trusted partner, and handle insurance plans copayment, and or coinsurance.