What would you do?

[Nique 1]

Good morning all!

I have recently started the process to go through WLS. However, I have two insurances. Aetna and MD medical insurance (Medicaid). So with Aetna I can possibly get approval within 4 months. But with Medicaid it takes 7. My surgeons coordinator recommended that I drop the Medicaid. Because their process takes longer, but I don't want the financial burden that I would incur as a result of dropping the secondary. Why would you do?

Also, if anyone has had this issue what guidelines did you follow? The primary or secondary. I really don't want to wait until winter to do the surgery.

Any suggestions would be appreciated!

[Kindle 8,667]

If Medicaid is your secondary, why would you have to drop it? Can't you just move forward with your Aetna guidelines? Just don't submit anything to Medicaid (unless you can slip it in as non-surgery related)

[Jersrose43 837]

You must follow the primary. Medicaid Is insurer of last resort and it's federal law that they require the other to pay first.

The truth of the matter is that the caid pays less than Aetna so what happens to the doc is that they get nothing more from caid and have to write off your copays and deductibles.

Keep both. Follow both rules. You will pay nothing. Bad for doc and hospital, as no additional payments, expect their frustration or counseling to drop it.

If you qualify you qualify why would you not protect yourself.

[Nique 1]

I called the secondary and they told me I would need to follow them if I wanted the portion not covered by aetna. Which kinda sucks.

[LumpySpacePrincess 594]

I had two different health insurances when I first went in for a consult and my coordinator told me the same thing. She said it is basically because if you have two health insurances they'll essentially fight over who has to cover it because neither of them really want to and you get caught up in all the red tape. Your primary will want the secondary to cover a certain percentage and the secondary will want the primary to cover it all. Plus if you have different waiting periods (4 months and 7 months like you stated) it can get fairly complicated. Its not as simple as just submitting to one insurance because they check to see what other health insurance you have by looking up through your SSN.

That said, 7 months seems like a long time but it took me about that long to prepare for surgery both psychologically and with all the pre-op requirements. I had to wait 2 months just to get an END consult, and then I had to wait another month just for an open appointment. The psych eval takes a little while to track down as well. To be honest, 7 months for nutritional counseling will prepare you much better than 4 in the long run. You'll be more knowledgable about what you should be doing post-op and how different types of food affect your body.

I know it sucks to wait that long, but a longer prep period before this major, life changing surgery will benefit you so much more in the long run.

[Nique 1]

I have my psych eval July 8th. sleep study scheduled. I need to schedule my nutrition appointment and do my support groups. I guess that's why I'm antsy because I scheduled things already.

I guess I'll have to stick out the 7mos.

[Kindle 8,667]

I have my psych eval July 8th. sleep study scheduled. I need to schedule my nutrition appointment and do my support groups. I guess that's why I'm antsy because I scheduled things already.

I guess I'll have to stick out the 7mos.

I was self pay in Mexico and I had to wait longer than that to save up the money and to schedule the surgery for when I could take 2 weeks off work. It will be totally worth the wait!

[Jersrose43 837]

So I work in health insurance so you need to know this:

There are federal regulations over who covers first

Medicaid always covers last as per federal law

You must follow both the insurance guideline of you want coverage from both

But extremely important is to follow the primary insurance company guidelines because if they do NOT cover than you're screwed because the policy on the 2nd will clearly disallow any coverage at all whether you followed their guidelines or not.

The only exception is the lack of coverage or benefit exclusion.

Follow both insurance guidelines to be truly fully covered

The coordination of benefits rules are clearly followed by all carriers nationally in the same way:

Your insurance from an employer pays first

Spouse insurance pays second

Any insurance where you are listed as dependent pays second

Medicare pays first for retired people only

If you are working and have other insurance medicare pays second

Tricare- federal insurance for military pays last after all commercial insurance payers pay.

Medicaid always pays last - carrier of last resort

Anyone who tells you different is sadly not good at insurance

You do NOT get a choice of who pays first/second etc. Your insurances have guidelines to follow especially with government funded entitlement plans.

Read your policy look for coordination of benefit clauses

[Jersrose43 837]

I had two different health insurances when I first went in for a consult and my coordinator told me the same thing. She said it is basically because if you have two health insurances they'll essentially fight over who has to cover it because neither of them really want to and you get caught up in all the red tape. Your primary will want the secondary to cover a certain percentage and the secondary will want the primary to cover it all. Plus if you have different waiting periods (4 months and 7 months like you stated) it can get fairly complicated. Its not as simple as just submitting to one insurance because they check to see what other health insurance you have by looking up through your SSN. That said, 7 months seems like a long time but it took me about that long to prepare for surgery both psychologically and with all the pre-op requirements. I had to wait 2 months just to get an END consult, and then I had to wait another month just for an open appointment. The psych eval takes a little while to track down as well. To be honest, 7 months for nutritional counseling will prepare you much better than 4 in the long run. You'll be more knowledgable about what you should be doing post-op and how different types of food affect your body. I know it sucks to wait that long, but a longer prep period before this major, life changing surgery will benefit you so much more in the long run.

There is no "fighting" or haggling. The rules are the rules

[Nique 1]

I am following both guidelines. Aetna has 3mos guideline and 6mos. Medicaid 6mos. I was choosing 3mos because I didn't want to get surgery in the winter. My surgeons coordinator was the one trying to get me to drop the secondary... I don't mind it since I have to it just wasn't my preference.

[Nique 1]

Medicaid 7 mos. sorry

[Jersrose43 837]

I am following both guidelines. Aetna has 3mos guideline and 6mos. Medicaid 6mos. I was choosing 3mos because I didn't want to get surgery in the winter. My surgeons coordinator was the one trying to get me to drop the secondary... I don't mind it since I have to it just wasn't my preference.

The Medicaid wil only save you from paying anything out of pocket