I would like to understand how two health insurance companies will co-ordinate their payment. Let's take the following example a person with the following coverage:
Primary health insurance:
(student - United Health Care)
Max out of pocket: $10K
Secondary health insurance:
copay: $30/$50 (PCP/Specialist)
Max out of pocket: $6K
The primary insurance is provided for free, and cannot waive as the person is an an international student.
The person recently got a bill for $1500 for a simple lab work that estimated by UHC and Cigna as just a few dozen dollars. Later the bill was consolidated to $500 by the secondary insurance.
I got an advice from a benefits consultant that UHC might not be the standard insurance with different pricing for services. However I am still having trouble understanding how that works as I have just the Cigna insurance and I had never paid more than $50 even if the visit included lab work.
My concern is that the primary health insurance sets the price, while the secondary insurance could have had a better price. For instance, imagine a person needs to visit a specialist that is fully covered by the secondary insurance with a copay of $50. If the person have not meet the deductible the might end up paying towards the $450 deductible.
Another concern that the secondary insurance deductible becomes unclear as it's up to the insurance provides to figure out how they split my money and what deductible I pay towards.
What would be your advice/insight on the situation.