Learn more about how Community Health Plan of Washington (CHPW) coordinates benefits between your health plans.
What is “other health insurance” (OHI)?
OHI is when you have coverage with more than one health insurance company or agency, or more than one health insurance plan with the same company. For example:
- CHPW Medicare Advantage Dual Complete (HMO D-SNP) + CHPW Behavioral Health Services Only (BHSO)
- CHPW Medicare Advantage Dual Select (HMO D-SNP) + a plan with a different health insurance company
To help avoid billing issues, it is important to tell us about any other health insurance (OHI) you may have and keep us up to date if something changes.
What is coordination of benefits?
Coordination of Benefits is when we work with another health plan to process and pay for health care services for a member that has more than one health insurance plan.
How does “other health insurance” (OHI) work?
You get care
When you get care, bring your health insurance cards for both health plans.
Your primary plan pays first
After your visit, your doctor sends a bill to your primary health plan.
Your other plan pays second
The provider must be in-network and the service covered by this plan.
You pay the costs left over
After both plans pay, you are responsible for remaining costs.
When you’re covered by more than one health plan, one is the “primary payer”, and the other is the “secondary payer.”
The primary payer pays first, up to their coverage amounts or limits. The claim is then sent to the secondary payer if there are costs that the primary payer didn’t cover.
You may still owe something after both plans have paid, depending on your coverage, the medical service, and the provider’s network.
Frequently asked questions
How do I know which health insurance plan is primary?
If you have health insurance through your spouse’s work, that plan is likely primary. In that case, your CHPW Medicare Advantage Dual Plan would be secondary.
We can help you figure it out so that providers know which health plan to bill first. Who your primary payer is depends on the type of other health plan you have and other factors.
Call our Customer Service team at 1-800- 942-0247 (TTY: 711) seven days a week, 8 a.m. to 8 p.m. or email [email protected] for help.
I have two health plans, and my claim was denied by CHPW for a covered service. Why?
If you’re trying to get a medical service paid for by CHPW, and your claim is denied because of your other health insurance, your doctor may be billing your health plans in the wrong order.
If you also have private health insurance, your CHPW Medicare Advantage Dual Plan is likely the secondary payer.
When CHPW is the secondary payer, we usually require proof that your other health plan was billed first before we can cover any costs. This can be an explanation of benefits (EOB) or a letter from your other health insurance company.
My other health insurance ended. Why are my claims being denied because of OHI?
First, check that your OHI information is correct in the myCHPW portal. If it’s not correct, update it following the how-to-guide below.
If your claims are being denied for covered health services because of other health insurance, and that other plan has been canceled, we may not have the most up to date information yet.
I don’t know if I have “other health insurance” (OHI). How can I check?
You can check if we have OHI on-record for you from your myCHPW portal. See the how-to-guide below for details.
We can also work with you to find out and make sure your care is covered correctly. Call our Customer Service team at 1-800- 942-0247 (TTY: 711) seven days a week, 8 a.m. to 8 p.m. or email [email protected].
What should I do if I have OHI and CHPW denied my claim because I didn’t have an explanation of benefits (EOB) from my other plan?
After your primary health plan pays their portion for a medical service you got, they will mail you an EOB or make it available online through their member portal. If you cannot find it, contact that health plan’s customer service to request a copy.
How to update your OHI on myCHPW
Log in to your myCHPW member portal, and look for “Other Health Insurance” under the “Member Self Service” tab.
For details, see the step-by-step instructions below, or read the myCHPW member portal user guide. “Find it in Chapter 7, How to Report Other Health Insurance.”
Step-by-step instructions
- Log in to the myCHPW member portal.
- At the top of the screen, click Member Self Services, then Other Health Insurance in the drop down menu. The Other Health Insurance screen is displayed.
- On the Other Health Insurance screen, click Add if you want to add other coverage.
- On the Add Other Health Insurance Form screen, click the type of other health insurance you are adding and complete the form. You will need to fill in everything marked with an *. If you see any updates that need to be made to your existing OHI (for example, your other coverage ended), update it in this screen.
- Optional: If you’d like, you can upload one file attachment, such as an Explanation of Benefits (EOB) from your other insurance. After choosing a file, click Upload.
- Click Save to finish later or click Submit when you’re done filling out the Other Health Insurance Form.
- You’ll see a confirmation message. Your information has been updated in our system.
- You can view the OHI information you have on record with us, by clicking View.
Once you submit the OHI form, you’ll be able to view the submitted OHI, but the submitted information cannot be edited.
Questions?
Call our Customer Service team at 1-800- 942-0247 seven days a week, 8 a.m. to 8 p.m. or email [email protected] if you need help to make sure your care is covered correctly.
What kind of care do you need? Not every medical issue needs emergency care. If you have a medical issue that doesn’t seem to be life-threatening, but you’re not sure what to do, see if your local Community Health Center clinic or primary care doctor offers virtual care. If they do, they will tell you how to set up your virtual care appointment.
