Will Secondary Ins pay?

[SleeveinIL 386]

I have 2 insurances, Aetna PPO and BCBSIL PPO. My surgery is scheduled for 3/16. I found out yesterday that Aetna will not pay for the surgery at the hospital scheduled as it has to be at an "Institution of Quality". There are 9 hospitals in IL and none of which my surgeon has privileges. I am not sure why this suddenly sprung up but that's another discussion. Aetna will not pay if I stay the course and have my surgery as planned. However, I do have a secondary that has approved/pre-certified everything. So I called BCBSIL and was put in touch with a "Benefit Value Advisor" where she advised the secondary ins looks at what the primary pays and then pays based off what they paid. So does anyone know if primary pays $0 and denies the claim, will the secondary pay according to the schedule the insurance has with the hospital. Bottom line, will the secondary pay even if the primary denies the claim? I don't want to be stuck with a expensive bill. Thanks in advance.

[ProudGrammy 8,322]

19 minutes ago, SleeveinIL said:

will the secondary pay even if the primary denies the claim?

@SleeveinIL

short and sweet answer - maybe/sometimes

6 years ago when i had my sleeve, my primary (Medicare) wasn't paying for the WLS the sleeve. they said it was experimental. That was IT, period, end of sentence. - (btw - sleeve is now covered by medicare!!)

i had many phone "discussions" with BCBS (2nd ins. from my office) about them allowing (paying) for my WLS. in the end - sleeve was covered and paid for completely - hospital too!! if you are told NO the first time - don't give up, try, try again!!!

good luck

kathy

[Danny Paul 761]

My surgeons office mixed up my insurances. They ran the surgery through my secondary insurance instead of my primary. When they called and said that I was approved I called my primary insurance to confirm. They had no idea what I was talking about. I called my secondary and they did have my surgery scheduled and paid for. My secondary told me it would be no problem if my primary declined to pay. If the primary paid even 1/2 the bill I would have to fight the secondary to cover the other 1/2. In the end my primary picked up the complete tab. In your scenario it appears the primary did not cover the surgery. In this case the secondary should pick it up. My primary is Emblem and my secondary is UHC.

In any case I would call up multiple people at your secondary and ask if they will cover if your primary does not. The reason I call multiple people is because I had the misfortune of asking for information regarding my pension and was given the wrong info by the person I called. It cost me quite a bit of money. If I had made multiple calls I would have gotten accurate info to base my decision on. Not all customer reps are competent as I have found out through the years. That's why like medical decisions I get a second (or third) opinion.