Dual Insurance Coverage

[rivergirl 5]

I have insurance through both my employer and my husband's. My primary is United Healthcare (mediocre coverage), and secondary is Cigna (fantastic coverage). I meet the requirements for WLS with both companies, however UHC requires 6 months of physician monitored diet and Cigna only requires 3 months. Do you think I can go ahead for Cigna approval after 3 months? Will there be any payment issues with Cigna if UHC never approved the surgery?

Thanks!

[hely88 883]

good luck

[KAATNS 1,473]

Your secondary won't pay until your primary has paid so I wouldn't risk it. I would recommend waiting the 6 months to get your maximum benefits from both companies. Good luck to you!

[rivergirl 5]

Thought I'd post an update in case this helps anybody else. My husband and I both talked to separate people at Cigna (the secondary), and were told that if UHC denied (whether b/c they don't cover OR b/c I didn't meet their requirements) then Cigna would become primary and would pay as primary. All they would need is a denial letter or EOB showing UHC paid zero. However, because they would become primary for this procedure, they are requiring that we have the surgery pre-authorized. Both people told us that they would cover at 100% after our deductible is met.

The dr's office also called to see what the coverage would be (this was just an informational thing, not anything official), and Cigna told them that they wouldn't pay until UHC paid. They did not tell the dr's office what they would pay if UHC denied. I mentioned this to the rep I spoke with a few days ago, and he emphatically said the person was mistaken. They will cover everything UHC does not cover (within the limits of our policy), regardless of whether UHC pays a small amount or zero.

When we get closer to the 3 months of supervised weight loss that Cigna requires, we can try to nail down a more firm answer, but for now we're waiting for a copy of the policy itself where it explains their coordination of benefits. Hub's HR department wasn't even sure about this, so they're working on it for us also.