In a Single Policy, whose coverage is typically primary?

In a single policy scenario, the patient's policy is typically considered primary coverage. This means that when a patient seeks medical treatment or services, their own health insurance plan will first be billed for the costs incurred. The reason for this is that insurance policies are designed to serve the individual members covered under that policy as priority.

When multiple insurance policies exist, the coordination of benefits (COB) rules come into play, which determine which policy pays first and which pays second. However, according to standard COB rules, there is usually a hierarchy, and the insurance coverage held directly by the patient is established as the primary coverage.

This principle also aligns with the insurance industry norms, ensuring that individuals utilize their own insurance first before relying on other sources like a spouse’s insurance, government assistance programs, or employer-sponsored plans that may offer secondary coverage. As such, the patient’s policy takes precedence and is billed accordingly for the care they receive.