I am in the habit of constantly asking clarifying questions and I ask the same ones over and over again to different people (I call frequently) and I get different answers all the time. I never truly know what's covered or how much it's going to cost. It's so much BS. The medical facilities give me more accurate information than Priority Health does. 3 Priority Health people have told me my son receives unlimited therapy visits because of his diagnosis, but I know that's not true, and I've had only 2 people tell me the correct number of visits he gets for his diagnosis. The pediatric office even knew the correct answer. How is this legal for them to be so wrong all the time? Ughhhhh

So my son receives ABA services through a tier 1 provider. This goes through deductible and coinsurance. $650 individual deductible, $2000 coinsurance (minus prescription and copay, solely for him, the numbers mentioned don't apply to family deductible). $0 is covered until the $650 is hit, 80% is covered until $2000 is hit, then 100% covered after. So I call up insurance because last year's bills are much higher than expected. I don't even know the total yet for just last year. And I can't look at the online EOBs yet until tomorrow. So, $650 is covered very quickly. Then there's a $6000 bill (for one date of service) sent to insurance. 80% is covered, we cover 20%. This is where I get so confused. Apparently because the first day wasn't processed first ($11,000) and this $6000 was processed first, she said we are actually paying so much less money overall for the year. We have to pay for the 20%... But it doesn't sound like it counts towards the $2000? We might be paying a total of $4,000-$5,000 once this is all said and done. It went like this... "So if I've already paid the $2,000 towards ABA, why do I have to pay over that?" "Because you're responsible for 20% after the $650 is paid until you reach the $2,000. You're actually paying so much less because that $11,000 wasn't processed first, so you're coming out on top. Otherwise you would have had to pay $2,2000." My brain hurts. I don't know what's going on. That would have put me over the $2,000 and it sounded like he still wouldn't have been considered as reaching the $2,000.... Someone please explain 😭

I’m new to the private insurance world, so if anyone knows the answers to these questions, I will take any bit of knowledge given. Here’s what I’m working with:  **-Priority health - HMO ($1,300 family deductible) -Through my employer, Corewell Health** **-State of Indiana Anthem - Healthsync POS with HSAS - ($6,000 family deductible) Through my husband’s employer in the state of Indiana**  * ***How do deductibles work? Policy states "You have to meet the deductible before coverage kicks in"?***  \[I’ve had Priority Health since 1/1/25 (Anthem did not become active until 3/1/25). Priority is saying I have met my family deductible of $1,300 but I am positive I have not paid anything remotely that close in office visit copays or on prescriptions. I’m happy about this, but it seems to me that I had some sort of coverage since the deductible is already met.\] * ***Is it beneficial to notify both insurance companies so that they are aware of “the coordination of benefits”?***  * ***Can I pick who my primary insurance is (for doctors' appointments and prescriptions)? Or does it not matter who is primary and who is secondary?***  \[I might be speaking too soon, but despite the higher deductible, it seems like my husband’s insurance, Anthem, is better.\] * ***Insurance math…??*** I recently picked up a prescription, and the pharmacy processed the insurance claims as follows: * Priority Insurance (primary): $15 copay * Anthem Insurance (secondary): $11 copay The pharmacy combined the two insurances and calculated the total copay to be $7. I'm unsure if this was processed correctly. My question is, with two private insurances, shouldn't the prescription be covered in full, resulting in a $0 copay? Additionally, will I still be responsible for paying an office-visit copay for in-network doctor visits under both insurance plans? \[My logic is that if I'm paying full premiums for two insurance companies, I should receive full coverage between the combined two insurance companies."\] * ***Do I have to run both insurances when filling a prescription?*** \-My husband is prescribed disposable insulin pumps, which required a prior authorization. However, the PA process took months to complete due to communication issues between Corewell Health and Priority Insurance. Fortunately, his disposable insulin pumps are now fully covered by Priority Health. Here's the question: Until the prior authorization expires, is he required to file claims through Anthem when picking up refills? Note that Anthem became his new insurance provider on March 1, 2025, through his employer, and was not involved in the current prior authorization. \[There are numerous prescriptions that Priority Insurance refuses to cover, but Anthem will. It seems like having to use both insurances could be a double-edged sword. The primary reason I have two private insurances is to mitigate the issues with prescription plan exclusions. Specifically, one insurance company will cover certain medications that the other will not, and vice versa.\]