Critical Reminder: Keep Your Insurance Info Updated

Preventing Huge Medical Bills with Proper Insurance Coordination

At Orchid, we do everything possible to ensure our learners have the correct insurance information. Over the years, simple mistakes (like a plan change within the same carrier requiring a new treatment plan) have cost us thousands of dollars and placed undue burdens on our families. As someone connected with other business owners, it’s not uncommon for a family to end up with bills in the tens of thousands of dollars due to mistakes in notifying their provider of changes. Along with the unforeseen financial impact on families and our organization, we don’t want to have your child’s services interrupted by insurance issues. This article is one more step Orchid is taking to ensure that families don’t experience the hardship of a large medical bill or any interruptions in service.

We want to remind everyone how much keeping your insurance information current matters. Ensuring your records are up-to-date can make a significant difference in the coordination of care for your child, especially if there have been recent changes in your insurance coverage or if your household now has a secondary insurance policy available for your learner.

Determining Primary and Secondary Insurance

When you manage multiple insurance policies, understanding which is primary and which is secondary is essential. Here’s a simple rule to follow:

Birthday Rule: The insurance of the parent whose birthday comes first in the calendar year (month and day) is considered the primary insurance. The other parent’s insurance is secondary.

Example:

• Parent X’s Birthday: January (Primary Insurance)

• Parent Y’s Birthday: March (Secondary Insurance)

In this example, medical claims are initially processed by the primary insurance (Parent X’s), and any remaining costs are then handled by the secondary insurance (Parent Y’s).

Benefits of Proper Coordination

Properly coordinating your insurance policies offers several key benefits:

1. Comprehensive Coverage: Ensures your child receives the necessary care without duplication of services.

2. Faster Processing: Efficiently manages claims between multiple insurers, reducing administrative hassles.

3. Reduced Denials: Proper coordination reduces the likelihood of coverage denials, providing smoother access to required services.

Effective coordination requires clear communication among your family, healthcare providers, and insurance companies. Without the correct information, unexpected financial issues may arise, impacting your family.

If you have any changes to your insurance or now have two insurance policies, please inform your healthcare provider or school. Keeping them updated helps ensure that your child continues to receive care without interruptions or financial surprises.

More coverage help: our ABA therapy insurance guide for Washington and contact form if you want Orchid to verify benefits with you.

What to send us, and when

Send a photo of the front and back of the new card, the subscriber name, member ID, group number if it is on the card, the child’s date of birth, and the effective date of the change. Email hope@orchidacademy.com or use the contact form. Same-day is better than “we’ll mention it at drop-off next week.”

Send it when any of these happen:

• New job, lost job, or a move between employers
• Open enrollment, even if you stayed with the “same” carrier
• A plan change inside the same carrier (this is the one that quietly requires a new treatment plan)
• Divorce, separation, or a custody order that names who carries health coverage
• A second policy appears (step-parent, new spouse, Medicaid/Apple Health alongside commercial coverage)
• The child is added or dropped as a dependent
• You get a new member ID for any reason

A Premera logo on a new card is still a new plan. Billing has to load the new ID, and authorization often has to be resubmitted.

The birthday rule, and when it does not apply

The birthday rule above is the usual rule when both parents are married or living together and both cover the child: the parent whose birthday falls earlier in the calendar year (month and day, not year) has the primary plan. If both parents share a birthday, the plan that has covered that parent longer is primary. That is the NAIC coordination-of-benefits model most commercial plans follow.

It does not automatically apply if parents are divorced, separated, or not living together. Then the order is usually:

1. A court order that names who is responsible for the child’s health coverage, if the plan has been told about it
2. If the order says both parents are responsible, or joint custody with no coverage assignment, the birthday rule comes back
3. If there is no order about coverage: custodial parent’s plan, then that parent’s spouse’s plan, then the non-custodial parent’s plan, then that spouse’s plan

If you have a decree, send it. Billing cannot honor a custody arrangement it has never seen. Claims billed to the wrong “primary” are a common way families end up with a balance in the thousands.

Medicare, Medicaid/Apple Health, and some self-funded employer plans have their own coordination rules. Do not assume the birthday rule wins those.

Why a “same carrier” change still breaks ABA

ABA authorizations are tied to a specific plan ID, not to a logo. A January 1 employer plan swap, a move from a fully insured plan to a self-funded one, or a new group number can mean:

• The old authorization is invalid on day one of the new plan
• Medical necessity paperwork has to go out again
• Deductible and coinsurance reset (see deductibles and HSAs)
• Network status can change even when the card still says the same carrier name

If therapy continues on the old ID, claims deny later and the family often gets a retroactive bill.

Coordination of benefits (COB) in practice

When two plans cover the child, primary pays first up to its allowed amount. Secondary may pay some or all of the leftover, depending on its COB language. Report the second policy. If we bill primary only and secondary existed, audits and recoupments show up months later.

Tell us about Apple Health even if you also have commercial coverage. Dual coverage is common and it changes which ID we have to bill first.

Frequently asked questions

What if I do not have the new card yet? Send the ID number from the insurer’s app or website, the effective date, and a note that the card is coming. Do not wait for plastic.

Will services stop the day my plan changes? They can, if we cannot bill the new plan. The way to avoid a gap is to send the new ID before the effective date, not after the first denied claim.

Who do I call besides Orchid? The insurer’s member services line, to ask which plan is primary and whether ABA still needs prior authorization. Then send us the reference number from that call.

Where can I read the coverage rules for Washington ABA? Start with the Washington ABA insurance guide. If a claim already denied, use what to do when an ABA claim is denied.