When a patient has Aetna single coverage and the spouse carries family coverage with Cigna, which plan is primary?

In determining which insurance plan is primary in cases where both a patient's plan and a spouse's plan are involved, the typical approach relies on the "birthday rule." If one spouse has individual coverage and the other has family coverage, the coverage for children under the family plan is typically primary. However, in this specific scenario, since the patient has Aetna single coverage, that plan is considered primary. This is because the patient’s own insurance (Aetna) provides coverage directly for the patient, while Cigna, held by the spouse, does not cover the patient directly. Hence, the individual coverage of the patient (Aetna) takes precedence.

Understanding this process is vital for healthcare providers to ensure that claims are submitted correctly, which can prevent issues in coverage and billing.