What is tertiary insurance? Who provides tertiary care?

What is tertiary insurance?

Tertiary insurance meaning and coverage: 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.

When it comes to healthcare insurance, things can really get pretty complicated. One term that you may come across is "tertiary claims". Basically, this is a claim that's submitted when a patient has a third insurance provider and there's still a balance left to pay. The claim is easily sent to the third carrier on a CMS form along with the EOBs from the primary and secondary carriers. It's just one more authentic step in the process of making sure medical bills are paid.

In this article, we are going to understand What is tertiary insurance, the 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

If you have a life insurance policy, you may have heard the term “tertiary beneficiary.” This simply means that they are the third person in line to receive the proceeds after the primary and secondary beneficiaries. It’s just an extra layer of protection for your loved ones.

What does tertiary insurance mean
What does tertiary insurance mean

Please 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 healthcare 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 comes into play.

Also Read – Compensation Mesothelioma: How much compensation will I get

What are primary, secondary, and tertiary insurance?


How to determine primary/secondary 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 is 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 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.

Tertiary Tangles

Define tertiary insurance: 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 Gaps

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 words, 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

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 facilities. 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 types of plastic surgery or neurosurgeries. It also includes severe burn treatments or skin burn-related treatments and any other very complex treatments or procedures.

Also ReadTypes of weight loss surgery, Best stomach surgery–GASTRIC BYPASS

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 a 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 the exact difference between primary, secondary, and tertiary insurance. Other Types of Insurance Policies and their conditions.

How to determine primary secondary tertiary insurance?

Is insurance a primary secondary or tertiary? Exactly you have coverage under your own insurance plan and under your spouse or partner’s plan. Please keep in mind that your own insurance plan is always the primary payor; your spouse or partner’s insurance plan is considered as the secondary payor.

So, in simple words: Primary insurance refers to the owner or insurance or first insurance listed, secondary insurance refers to the second insurance listed, and tertiary insurance refers to the third insurance listed.

How do you determine which insurance is primary and which is secondary?

The “primary payer” pays what it actually owes on your bills first, and then the next step sends the rest to the “secondary payer” to pay. The insurance that pays first is simply called the primary payer. The primary payer(primary insurance owner) pays up to the limits of its coverage. The insurance that pays second is called the secondary payer or secondary insurance.

What is the difference between secondary and tertiary insurance?

When it comes to healthcare insurance, you might hear terms like primary, secondary and tertiary insurance. The primary insurance is the first listed on the Patient > Insurance tab, the secondary insurance is the second listed and the tertiary insurance is the third listed. Actually, it’s all about order of coverage.

How do I know if my Medicare is primary or secondary?

Medicare actually pays first and your group health plan (retiree) coverage pays second. If the employer has lots of or 100 or more employees, then the large group health plan pays first, and Medicare pays second.

How do I determine which insurance is primary?

Primary insurance is a health insurance plan that simply covers a person as an employee, member, or subscriber. Primary insurance is billed first when you actually receive health care. For example, health insurance you receive through your employer is almost or typically your primary insurance.

When two insurance which one is primary?

If you have two insurance plans, your primary insurance is actually your main insurance. Except for company retirees on Medicare, the health insurance you receive via or through your employer is simply or typically considered your primary health insurance plan.

What is secondary insurance?

Secondary insurance is a pure health insurance plan that simply covers you in addition to your primary insurance plan. Typically, secondary insurance is billed when your primary insurance plan is actually exhausted and may help cover some extra or additional health care costs.


What kind of coverage does tertiary insurance provide?

The coverage provided by tertiary insurance will depend on the policy and the insurance provider. However, it typically covers the remaining balance of medical bills after the primary and secondary insurance providers have paid their portions.

How do I know if I have tertiary insurance?

Check your insurance policy documents or contact your insurance provider directly to perfectly find out if you have tertiary insurance.

How does tertiary insurance work?

After the primary and secondary insurance providers have paid their portions, the remaining balance is submitted to the tertiary insurance provider for coverage. Actually, this ensures that medical bills are paid in full and the patient doesn’t have to pay out-of-pocket.

Do I need tertiary insurance?

It depends on your individual circumstances and insurance coverage. If you really have primary and secondary insurance providers and still find yourself with a balance to pay, tertiary insurance could be beneficial.


Hi, My name is Helena and I’m a founder of HealtHowdy.com. Over the years I’ve helped hundreds of people to live a healthy and fit life. Nowadays, Fitness is everything, if you want to Look Attractive and Get Updated, you can Join Me. WhatsApp

Leave a Comment