For a married patient where both spouses have group insurance, which policy is typically primary for the patient’s appointment?

For a married patient where both spouses have group insurance, which policy is typically primary for the patient’s appointment?

• A. The Wife's Insurance
• B. The Husband's Insurance
• C. The Plan with the Higher Premium
• D. The Plan with the More Comprehensive Benefits

Answer: (A)

Coordination of benefits governs which insurance pays first when a patient has more than one group policy. When a married patient has dual coverage, the plan that pays first is the one that covers the patient as a dependent under that policy. In many teaching materials for CBCS, this is described as the spouse’s plan being the primary payer for the patient’s visit, with the other spouse’s plan acting as secondary. That’s why the wife’s insurance is typically billed first: the patient is treated as a dependent under the wife’s plan, so it pays before the other policy. The secondary plan would then coordinate to cover remaining allowed charges. If the patient is actually the primary insured on their own employer plan, that plan would be primary instead. But in common practice question scenarios, the default assumption is that the spouse’s plan is primary for a patient who has dual group coverage.

Coordination of benefits governs which insurance pays first when a patient has more than one group policy. When a married patient has dual coverage, the plan that pays first is the one that covers the patient as a dependent under that policy. In many teaching materials for CBCS, this is described as the spouse’s plan being the primary payer for the patient’s visit, with the other spouse’s plan acting as secondary. That’s why the wife’s insurance is typically billed first: the patient is treated as a dependent under the wife’s plan, so it pays before the other policy. The secondary plan would then coordinate to cover remaining allowed charges.

If the patient is actually the primary insured on their own employer plan, that plan would be primary instead. But in common practice question scenarios, the default assumption is that the spouse’s plan is primary for a patient who has dual group coverage.