primary and secondary insurance

[Khy 16]

Aetna is my primary insurance and tricare standard is my secondary insurance. Will tricare pay anything since they are secondary? I know they paid part of my hysterectomy but I am thinking maybe this is different since they have taken a hard line against approving vsg outside of a mtf? Anyone have any experience in this area?

Khy

[Texasgrl 2]

I have the same for Insurance so I will be curious if you are approved by both.

Aetna is my primary insurance and tricare standard is my secondary insurance. Will tricare pay anything since they are secondary? I know they paid part of my hysterectomy but I am thinking maybe this is different since they have taken a hard line against approving vsg outside of a mtf? Anyone have any experience in this area?

Khy

[Tiffykins 673]

No, Tricare standard as a secondary will not cover it outside of an MTF. I've had one lady contact me that got it covered with a civilian, BUT her husband is retired, they had Prime (Tricare for LIFE) they switched her (only to Tricare Standard through John Hopkins, and she had VSG covered with a civilian surgeon with the normal out of pocket Standard fees, and now she has to stay on this John Hopkins health plan because it's not a covered procedure and she did it outside an MTF).

That's the only way I've seen anyone get it covered outside an MTF, and with a more "Standard" policy vs. Prime, however, it's only available at John Hopkins health plan through Tricare for Life recipients from everything I've read.

2 members on obesityhelp just went through the same thing, and the additional charges not covered by Aetna (for one of them) and United Health care (For the other) were both denied payment due to VSG not being a covered procedure.

[Texasgrl 2]

Thank you, I am still going to try and get it approved as I believe we have Tricare (Remote) otherwise I will pay for the rest out of pocket.

No, Tricare standard as a secondary will not cover it outside of an MTF. I've had one lady contact me that got it covered with a civilian, BUT her husband is retired, they had Prime (Tricare for LIFE) they switched her (only to Tricare Standard through John Hopkins, and she had VSG covered with a civilian surgeon with the normal out of pocket Standard fees, and now she has to stay on this John Hopkins health plan because it's not a covered procedure and she did it outside an MTF).

That's the only way I've seen anyone get it covered outside an MTF, and with a more "Standard" policy vs. Prime, however, it's only available at John Hopkins health plan through Tricare for Life recipients from everything I've read.

2 members on obesityhelp just went through the same thing, and the additional charges not covered by Aetna (for one of them) and United Health care (For the other) were both denied payment due to VSG not being a covered procedure.

[Khy 16]

Well I am going to ask them to file it with tricare standard ( that is what I have) as a secondary insurance. If they pay some of it ... good ... if they don't... I didn't lose anything trying.

Khy