According to the NON-Dependent or Dependent Rule, which plan is billed first when a patient is covered under two plans?

When determining which insurance plan to bill first under the NON-Dependent or Dependent Rule, it is essential to recognize the priority of coverage based on the patient's role in relation to the insurance policies. If a patient is covered by two insurance plans, the plan under which the patient is the subscriber takes precedence and is billed first.

The rationale for this rule is rooted in the principle that a subscriber, or primary policyholder, has a more direct financial relationship with their plan, as they have contracted for coverage themselves. This priority helps to ensure that claims processing is streamlined and consistent, reducing potential confusion in billing.

In this case, the other options do not align with this prioritization. For instance, billing the plan for which the patient is a dependent would typically apply if the patient were covered by a parent's or guardian's insurance, but that is not the priority outlined by the NON-Dependent or Dependent Rule. Similarly, the plan with the higher premium or the plan that offers the most comprehensive coverage are not criteria for determining the order of billing; these decisions are based on individual plan terms rather than subscriber status. Understanding this hierarchy is crucial for effective claims processing and adherence to insurance policies.