Greg Owen is in the office today for treatment of a small but deep cut he received while cutting laminate for the new floor in his kitchen. He has employer-provided insurance and is also listed as a dependent on his wife's insurance. His DOB is 7/19/1973 and his wife's DOB is 5/23/1978. Who is the primary payer in this case?

Question

Quizplus · Accepted Answer

The primary payer is determined by the "birthday rule," which states that the insurance of the person whose birthday (month and day, not year) comes first in the calendar year is the primary payer. However, in this case, since Greg is the patient and the insurance is his employer-provided insurance versus being a dependent on his wife's plan, his own insurance would be primary regardless of the birthday rule. The birthday rule typically applies to dependent children when determining which parent's insurance is primary. Greg's and his wife's birthdays and their ages are red herrings in this scenario. Medicare, Medicaid, and Workers' Compensation are not relevant to the primary insurance determination in this context.

Greg Owen Is in the Office Today for Treatment of a Small