The subscriber rule is applied to situations where the subscriber or their

The subscriber rule is applied to situations where

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The subscriber rule is applied to situations where the subscriber or their spouse has an active health insurance plan and a COBRA plan. The subscribers active health insurance plan is primary. Also, if the patient has an active and an inactive plan, the active would be primary. If there are two active health insurance plans, the primary is the one that has been active longest. The medicare secondary payer rule refers to medicare covering services while it is not the primary insurance. Medicare is primary when the patient is 65 or older with a small group health plan through either their employer or the spouse's employer, 65 or older with insurance through a retirement plan, or disbaled and has small group health plan through their employer or spouse's employer. The third party liability insurance rule applies to accident related services. This includes motor or auto insurance, workers compensation insurance, homeowner insurance, malpractice insurance, and business liability insurance. Payments collected from the patient at the point of service are copayments, coinsurance, and deductible. A copayment is made by the patient in addition to a payment being made by the insurer and is due at the time of the visit. Coinsurance is the percentage that the carrier and the patient pay. A deductible is the amount that must be paid out of pocket by the patient before the insurance will cover services.
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  • Summer '19
  • Dr T

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