UNDERSTANDING SECONDARY INSURANCE PLANS
If you are covered by more than one insurance policy, one policy is the PRIMARY policy and the other is SECONDARY.
Which plan is primary is determined by insurance company rules. Unfortunately, you do not get to choose.
When you receive services, the primary policy must be billed first. The secondary policy will not pay unless the primary policy has been billed.
Our office only bills insurance plans that we are contracted with as a network provider. You can find a list of those plans on our website. We do not submit to insurance if we are “out-of-network.” If you have two insurance plans and we are not in-network with your primary insurance, we cannot see you at our office.
How to Know Which Plan is Secondary
Insurance plans follow some basic rules to decide which insurance plan is primary:
- If the person has a commercial insurance plan and Medical Assistance, the commercial insurance is always primary. Commercial plans include insurance through an employer, plans purchased on the ACA Marketplace, and CHIP plans, just to name a few. Medical Assistance is always the “payer of last resort.”
- If the person is a child with more than one insurance plan, the primary plan is based on the policy holder’s date of birth. Whichever policy holder’s birthday is closer to January 1 is the primary policy. For instance, if Parent A was born March 3 and has Capital Blue Cross, but Parent B was born May 22 and has Highmark, Capital Blue Cross will be the primary plan because Parent A’s birth date is closer to January 1.
- If the person has insurance through their employer and a second plan through their partner’s employer, the insurance through their OWN employer is primary.
Determining If Campbell Psych Works With Your Insurances
If you have more than one insurance plan, there are a number of different scenarios. We need to consider two things.
First, are we in-network with your primary insurance? Then, are we in-network with your secondary insurance?
Remember, in-network means that Campbell Psych has a contract with the insurance plan and our providers are credentialed as part of the plan’s provider network. A list of insurance plans with which we are in-network is available on our Rates & Insurance page. If an insurance is not listed on that page, we are an out-of-network provider.
| Primary Insurance | Secondary Insurance | Can I be seen? |
|---|---|---|
| In-network | Medical Assistance | Yes, but you must be seen by a licensed therapist so we can bill your primary insurance. We will bill both plans. |
| In-network | In-network | Yes. We will bill both insurance plans. |
| In-network | Out-of-network | Yes, but only the primary insurance will be billed by our office. We will not bill your secondary insurance. You’ll be responsible for any co-pay or deductible under your primary insurance plan. |
| Out-of-network | In-network | No. Unfortunately, you cannot be seen at our office. |
| Out-of-network | Medical Assistance | No. Unfortunately, you cannot be seen at our office. |
| Out-of-network | Out-of-network | Yes, you can be seen as a self-pay client. Payment is due at the time of service. Upon request, we are happy to provide you with a “superbill” that you can submit to your insurance plan(s). We will not bill your insurance for you. |