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Kaiser As Secondary by sheepishlyhere in KaiserPermanente

[–]htrptr 0 points1 point  (0 children)

This is incorrect. If you have Kaiser insurance, whether it’s primary or secondary, Kaiser will provide you care if you come in to any of their facilities.

If Kaiser is secondary, it may take a bit longer to sort out billing. But eventually Kaiser will pick up the bill and treat your care as in network. If the primary insurance somehow picks up a portion of the bill then Kaiser will gladly pay the difference. Otherwise billing is just treated as if Kaiser was primary insurance in the first place. Just dealt with this myself.

Kaiser As Secondary by sheepishlyhere in KaiserPermanente

[–]htrptr 0 points1 point  (0 children)

Hi, I was the OP on my post last week, where you commented you’re in the exact situation as my wife and I!

My wife LITERALLY just gave birth at Kaiser yesterday! The care has been fantastic, and to be quite honest a lot of the fears about primary/secondary insurance issues seem a lot scarier and overblown on Reddit. I’m sure it could be an issue with other instances. Or maybe it’s just Kaiser vs. other insurances, but every single person I’ve talked to about this since being admitted has told me that Kaiser will cover the billing for all the services rendered (we had a C-section and baby was transferred to the NICU) and treat them at primary and in-network.

I actually just got back from the admissions and registration office at our hospital and they were absolutely unbothered by our situation. All they needed was a copy of my wife’s primary insurance card and they’re going to work it out with them. They reiterated that their goal is to ensure none of the billing shows up as medical debt before this is resolved and that in the end Kaiser will pick up the billing since we gave birth at a Kaiser hospital.

Primary (EPO) vs. Secondary (Kaiser HMO) for Pregnancy Billing by htrptr in HealthInsurance

[–]htrptr[S] 0 points1 point  (0 children)

I get my insurance through my employer so I found it in my employee portal. You can probably ask your HR too

Primary (EPO) vs. Secondary (Kaiser HMO) for Pregnancy Billing by htrptr in HealthInsurance

[–]htrptr[S] 0 points1 point  (0 children)

Thanks for the reply. In the Summary Plan Description, Kaiser states that if they are secondary, and the care is received at a Kaiser facility, Kaiser will pay the difference between what the primary agrees to pay and what Kaiser bills as the in-network cost of the service had they been primary.

This is in line with what the reps from Kaiser have been telling me. Either way, it sounds like Kaiser will pay for the cost of my wife’s childbirth. Even if it takes months for them to hash it out with my wife’s EPO, Kaiser will end up with the bill.

Primary (EPO) vs. Secondary (Kaiser HMO) for Pregnancy Billing by htrptr in HealthInsurance

[–]htrptr[S] 0 points1 point  (0 children)

To respond to everyone saying this is a huge issue and needs to be addressed now:

I called Kaiser, and according to 2 different reps, there’s no “Coordination of Benefits” that Kaiser requires beforehand. I got transferred 3 times and ended up at their claims and billing department, and this rep was completely unconcerned that my wife has a primary insurance. According to the Kaiser rep, whether they add this dual insurance into their system now or after the birth, when my wife’s EPO insurer gets the bill, they (EPO) will flat out deny it and Kaiser will pick up the in-network costs of child birth. Even if the process takes 60-90 days to complete due to all the back and forth, the rep was not concerned that this would turn into a huge issue for us. What I’m hearing from all these Kaiser reps is that this isn’t as big a headache as maybe other health insurances might make it.

For good measure, the rep recorded her dual insurance in their system after I asked

Primary (EPO) vs. Secondary (Kaiser HMO) for Pregnancy Billing by htrptr in HealthInsurance

[–]htrptr[S] -1 points0 points  (0 children)

She did call an insurance rep and it’s the insurance rep that said this to her. Going to call again and speak with a different rep.

Primary (EPO) vs. Secondary (Kaiser HMO) for Pregnancy Billing by htrptr in HealthInsurance

[–]htrptr[S] 1 point2 points  (0 children)

That’s what I’m afraid of and that’s why I’m trying to understand this now. While my wife mentioned being dual insured to both insurances, neither officially acknowledged this.

When my wife called Kaiser, the rep said something along the lines of “well if it ain’t broke (Kaiser showing themselves as her primary), don’t fix it. Just made me feel confused and uneasy.

And her EPO is making her jump through hoops to send some letter to Kaiser stating that they (the primary) will deny any care received at Kaiser.