What is tertiary insurance?
Actually, tertiary insurance is a third policy or third payer. In short, when you have multiple insurance policies, such as if you have Medicare and a supplemental policy, it is clearly possible to have more than one covering a given procedure or loss. The third one to be billed is referred to as tertiary coverage or tertiary policy protection. So, stacking policies can be helpful in that one may cover an expense that the other one actually doesn’t while a third one may pay your deductible or copay for you. In this article, we are going to understand What is tertiary insurance, what its policies and conditions of tertiary insurance and everything you want to know about tertiary insurance. You will find the actual difference between primary, secondary and tertiary insurance.
Tertiary insurance meaning
What is tertiary insurance? Keep in mind, tertiary insurance doesn’t always relate to Medicare or Medicaid. So, tertiary means that it is the third payer. This could be the actual result of having (non-Medicare/Medicaid) health insurance from multiple places.
In addition, when more than one insurance policy covers a claim, the carriers need to perfectly work out who’s going to be responsible for what. Actually, this situation happens in the health care world, where two spouses may both have family medical coverage, and a child’s medical bills are submitted to two different insurance companies. In this scenario, tertiary or supplemental insurance actually sometimes come into play.
What are primary, secondary and tertiary insurance?
When you are covered by two insurance policies, and submit a claim, in that case, one of the carriers must be the primary, and another one be the secondary. Primary insurance would really cover all costs under its policy limits, while the secondary would pick up some additional costs if the secondary policy covers these costs and the primary actually does not. Thus, tertiary insurance is “third-level” or supplemental insurance that will perfectly cover additional claims. In many cases, it’s a benefit offered to employees alongside a basic individual or family health insurance.
Tertiary can also clearly mean “third” beneficiary on a life insurance policy. When you actually buy life insurance, you must perfectly designate a beneficiary who will receive the death benefit if you pass away. You can also mention or designate a second (or contingent) and third beneficiary; if your primary and secondary beneficiaries also happen to die or pass away before the death benefit can be paid to them, then the tertiary becomes the primary. Tertiary can also clearly and perfectly mean a beneficiary who receives a third portion of the death benefit. This actually only happens if you name more than one individual beneficiary on the policy.
Billing tertiary insurance for a claim can be a really complicated procedure. Medical billing offices are supposed to solve or sort out the order of claims to be paid, but some insurance companies will often dispute the claims – especially if there is liability involved (such as in a work injury or car accident). In some cases, the claim of a medical provider against a tertiary carrier will have to go to court for justice, where a judge has to straighten out the claims.
Multiple Health Policies
It’s really not uncommon for families to have multiple health policies, leading to situations with tertiary insurance. For instance, a collegian or college student with divorced parents may have coverage from each parent and an additional, tertiary, policy offered through his college. Some families with coverage may also qualify for a state-administered Children’s Health Insurance Program in addition to their extra private coverage.
Supplementary Health Coverage
Tertiary supplementary policies actually work hand-in-hand with existing health insurance policies. For instance, you may have an existing high-deductible health insurance policy that pays for your surgical treatment and a secondary policy that helps to defray your deductible. A tertiary supplementary policy can really help to pay your other out-of-pocket costs. If you have two health insurance policies, like in some cases or in a situation where both you and your spouse are covered by your own policies, any additional insurance would technically be tertiary.
Medicare is perfectly set up to work with tertiary policies. Given that there are some areas Medicare doesn’t cover, many senior citizens choose to select or purchase secondary Medigap policies that actually protect them further. Any coverage in addition to Medigap would be tertiary insurance. This could actually include a supplemental policy for out-of-pocket costs, a travel policy for coverage when abroad, or insurance through a family member or employer.
Other Types of Insurance
Health insurance actually isn’t the only area where you can end up with tertiary coverage or tertiary insurance. Rental cars could be perfectly covered by your auto insurance policy, your credit card’s policy and any insurance through the rental car agency. In other word, credit card purchase protection can also be a third line of insurance policies, working with your primary renters or homeowners insurance and with any additional riders or separate policies you buy. In short, travel insurance may also be tertiary for you.
Quaternary care is actually considered to be an extension of tertiary care. It is even more specialized and highly unusual in some specific cases.
Because it is so specific and for some selected cases, not every hospital or medical center offers Quaternary care facility. Some may only offer Quaternary care for particular medical conditions or systems of the body.
Tertiary Care and Hospitalization
Once a patient is hospitalized and if a patient needs a higher level of specialty care within the hospital, he may be referred to tertiary care or tertiary insurance policy. Tertiary care actually requires highly specialized equipment and expertise.
At this level, you will find some health-related procedures such as coronary artery bypass surgery, renal or hemodialysis, and some type of plastic surgery or neurosurgeries. It also includes severe burn treatments or skin burn-related treatment and any other very complex treatments or procedures.
A small, local hospital may not be able to provide these special services, so you may need to be transferred to a medical center from local hospital that provides highly specialized tertiary level services.
Studies have perfectly shown that in the management of certain chronic conditions such as diabetes and chronic kidney disease, it is still very important for the primary care provider to be involved when a patient enters tertiary care. Having the PCP (Primary Care Physician) involved may enhance long-term self-management by the patient. Now hope you perfectly understand, what is tertiary insurance and exact difference between primary, secondary and tertiary insurance. Other Types of Insurance policies and their conditions.