Who is Billed First Marketplace or Employer Plan?
Our insurance thru our employer dropped the specialized therapy (Applied Behavioral Analysis) and we purchased a Blue Cross ACA plan that will cover the benefit for this specialized therapy that our son with autism needs.
Since our employer’s insurance won’t cover it how do we bill Blue Cross to cover this therapy?
Bill our employer first, it will be rejected then bill it to Blue Cross?
Answer
he case where two coverage options are needed there is usually a standard flow for who gets the claim first. Usually employer coverage get's the claim first.
However, here you know that the employer plan won't cover what you need, so you would most likely have the behavioral analysis claim made to the Marketplace plan only.
That being said, you'll have to ask both your insurers about this one.
Just to be clear, you can't get cost assistance on the Marketplace plan if you have employer coverage.