Primary and secondary insurance question

[Cami1908 30]

Does anyone have any experience with this or a similar scenario: I have Anthem *** as my insurance thru my job. There is no WLS rider. I recently got married. I was added to my husband's insurance for his job and it is BCBS PPO and WLS is covered. In order to be put on his insurance I had to KEEP my insurance thru my job and use his as a secondary. That being said, one doctor's office I contacted about having WLS told me that if my primary insurance doesn't cover the surgery then my secondary will not either. However, I called my husband's insurance and the rep that answered told me that wasn't the case; they needed to submit the pre-authorization form and go from there. Any experience with primary and secondary insurances. I've never had a secondary ins before. But I REFUSE to take their no for an answer. I need to get turned down by a few more offices with the same reason bc I don't c how the insurance rep would be wrong? Any help would be appreciated.

[Chaparra 85]

I actually work a lot with insurance companies (not for WLS though), and have been in the health care industry business since 1994. My experience is that most secondary insurances pick up the cost that the primary insurance doesn't pay for, providing that you follow your primary payers rules. Considering that you primary insurance doesn't cover WLS, I would think that as long as you have something from your primary saying that and give that to your secondary, you should be ok. I have never worked with the two insurances you have, but this has been the experience I have had with others.

[Cami1908 30]

Thanks Chaparra. That's what I was thinking. I don't trust that initial doctors office. I had been in contact with them via phone conversations for at least 3 weeks - each call explaining just what I explained above and NEVER did they say that secondary wouldn't cover it simply bc my primary didn't cover it at all. Then out the blue when I'm following up with them about attending their seminar (for the second time - first time I only had my insurance) she says "u do know that blah blah blah". I'm like where is this coming from??? U didn't mention that the other bazillion times we talked!!! An insurance rep from that secondary insurance even called her on three-way to tell her that wasn't necessarily true and she GOT AN ATTITUDE with him. Highly unprofessional. I've since moved on and will attend another seminar and try going thru a more professional hospital. I'm not claiming it and I'm staying positive and keeping the course. I appreciate ur thoughts! Thanks so much.

[Chaparra 85]

Yeah, I would probably look for another hospital too. We are making a life changing decision here and need to be comfortable and confident in the surgeon we choose and their staff. Good luck!

[Cami1908 30]

Amen to that!!! Their customer service left a lot to be desired.

[sweetcurves3 57]

My experience with primary and secondary is with anthem bcbs with my job and they do not cover any bariactric or anything with weight loss either. I had secondary medicaid and it was a covered benefit and they paid the cost for the surgery with no problems. The dr office did try and get pre authorization from bcbs 1st being that it is my primary then filed with medicaid. I was able to get surgery done 2/18 before my medicaid was cut off. I would try with another facility if you have that option. Good luck sweetie, I'm glad to hear that it seems you are not going to take no for an answer!

[Cami1908 30]

Thanks SC3. I just don't feel that their answer is THE answer. I am currently trying with Chesapeake Regional. I've had a procedure there before and I feel they are better equipped for working with insurances. They definitely are more professional, helpful and informative!!! I'm also lucky enough to have a friend who has had a WLS surgery before and who is one of the best supporters I know! Thanks again for your response. I will definitely post my journey and any answers I receive.

[Cami1908 30]

Well I have heard back from Chesapeake General. Sooooo glad I did not settle for the insane information the other center was giving me. Chesapeake General says its a go to start the process. I told her what the staff at Riverside Weight Loss told me and she even told me that it was not true (that secondary insurance wouldn't pay if the primary insurance didn't cover it). She even went as far as to tell me exactly how the paperwork is submitted. She also said "Wow. Well that's good bc that means we will get more people." I agreed. Because AS SOON AS I have my procedure I am calling them and making sure I personally let the doctor know that his staff is turning away people (and doing so with nasty attitudes) bc they don't know how to work the insurance aspect of things!!! He needs to know who he has on his support staff don't u think!!! Thank u two for ur responses. It really kept me motivated to seek services else where. And I won't even get into how much more informative and helpful Chesapeake Regional has been in 3 or 4 days than riverside was in over a month's worth of back and forth phone calls!!

[Cami1908 30]

Now I just have to revisit which procedure to have. I was set on the sleeve (hence me joining this group LOL) but the doctor there is pro-bypass I can tell. If anyone had any points on either they'd like to share if be open to them.