Question about primary vs. secondary insurance

[extxn71 0]

Hi everyone!

You guys seem pretty experienced concerning the ups and downs of dealing with insurance companies. I'd love some clarification if anyone can help :tongue_smilie:. Here's my situation:

My primary insurance does not cover lapband surgery, only gastric bypass. However, my secondary insurance (through my husband's employer) does cover the lapband procedure. My question is this:

Would my secondary insurance automatically cover the lapband procedure for me (assuming I met all of their requirements) since my primary doesn't cover this procedure at all?

Thanks

:tt1:

[Futr littl Debi 0]

Usually, if you have coverage under 2 policies, there is a coordination of benefits clause. You need to read that section of your secondary policy. The typical coordination of benefits says that if the insurance is secondary, they will pay up to the amount they would have paid if they were primary. In the case where the primary insurance doesn't cover a specific procedure, the secondary insurance would cover it up to their regular policy limits. If this is the case with your policy, you would need to get a letter of denial from your primary insurance to submit to the secondary insurance as proof of what the primary insurance paid - $0.

Remember - all insurance is different and what is in the policy will tell you what your coverage is in this circumstance. After you read the coordination of benefits section, call customer service at your secondary insurance to see what your next steps are.

Good luck!

[jodrae 0]

I had the same situation. My primary would not cover a thing. My secondary (through husband) covered 80%. I still had to meet the requirments. Also, they had to submit it through primary first to get the denial letter and then submit through my secondary. It took a few extra days. Hope this helps!

[ML in VA 0]

I'm actually dealing with primary/seconday insurance issues right now. I got word today that Cigna (primary) denied me due to lack of medical necessity and 24 month BMI. I called Tricare and was told that a referral is not needed and all my surgeon has to do is submit the authorization. Can it be that easy?? Not getting my hopes up. You would think it would be easier with 2 insurance plans, but it sure isn't. :embaressed_smile: