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Law Educator, Esq.
Law Educator, Esq., Attorney
Category: Legal
Satisfied Customers: 118788
Experience:  JA Mentor -Attorney Labor/employment, corporate, sports law, admiralty/maritime and civil rights law
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I am employed in the state of Florida .I have Aetna PPO

Customer Question

I am employed in the state of Florida .I have Aetna PPO as primary insurance with HRA savings account with my employer. I also have secondary insurance with my husbands insurance through Cigna .They have been taking all the outstanding medical and lab expenses from my HRA savings before submitting to my secondary insurance. Previously I had United Healthcare and they would allow me to submit to secondary prior to spending down my HRA account. Is Aetna doing the right adjudication of my claims.? I spoke with my HR representative he states they are doing the right thing but I feel if I have a secondary insurance this should be utilized prior to my HRA savings account. Please send me your advice. Thank You Anna***** *****
Submitted: 2 years ago.
Category: Legal
Expert:  John replied 2 years ago.
Hi, thanks for submitting your question today. My name is John. I have over 13 years of legal and consulting experience in this area. I’m happy to assist you with your question today.
If you have secondary insurance it only pays the residual after your primary insurance pays. In this instance, the your PPO is your primary insurance and should be charged first. Perhaps United health had different coordination of benefits rules than Cigna which causes Aetna to be the primary insurer all the time in your case. You can generally follow this article(http://personalinsure.about.com/od/insurancetermsglossary/g/coordination-of-benefits.htm) which explains how health plan coordination of benefits works. While there is some wiggle room, the primary generally always gets charged the full claim first.
I believe this answers your question. However, if you need clarification or have follow-up questions regarding this matter, I will be happy to continue our conversation – simply reply to this answer. If you are otherwise satisfied with my response, please leave a positive rating as it is the only way I am able to get credit for my answers; otherwise the website just keeps your payment and doesn’t credit me at all. Thank you, ***** ***** wish you all the best with this matter.
Customer: replied 2 years ago.
My question was not answered .I want to know if they should be taking funds from my HRA account before my secondary has paid my benefits . I know primary insurance pays first and secondary second then should come the HRA savings plan. Please confirm this process
Expert:  John replied 2 years ago.
They should only take cash from the HRA after the secondary is fulfilled its obligation. Your HRA is a discretionary fund, i.e., you could just leave it unfunded for ecample and the secondary insurance would pay its portion and the rest would be a cash charge to you....where the HRA comes in is that you can find that account and pay your charge tax free.
Customer: replied 2 years ago.
I just required confirmation of the correct process in this matter .Do you know any laws that I would be able to refer to regarding this process ?Where I could get a copy to provide to my employer and Aetna?
Expert:  Law Educator, Esq. replied 2 years ago.
Thank you for your question. I am a different contributor and have a little different information for you for educational purposes only.
Before an HRA payment is processed, both insurance providers need to pay on the claim. See: https://www.cdphp.com/consumer-directed-health/tips-and-tools/managing-hra-with-two-commercial-insurances
This is the process and that is what you can submit to your employer to show them that the two insurance claims need to be processed and then they would take from your HRA.