Michelle Andrews answers a question from a reader about who pays first when there is coverage from two insurance plans.
QUESTION: I have a high deductible health insurance policy and my wife is in an HMO. I use the HMO for medical services and use my HRA to pay long-term care insurance premiums and dental expenses. This year, the HMO began sending bills to my insurer instead, so now money is being drained from my HRA account. Can this be stopped? — Peter
ANDREWS: It probably can’t be stopped. It sounds as if what you’re describing has to do with so-called “coordination of benefits” rules. These are rules that spell out which insurer is responsible for paying first and which pays second in situations where someone is covered under two different policies, in this case yours and your wife’s. Benefits experts I asked said that in general if you’re covered as an employee under your employer’s plan that policy is going to be responsible for paying your claims first. Your wife’s plan, under which you’re covered as a dependent, would generally pay second, perhaps, for example, covering benefits that your primary insurer doesn’t cover.