Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Question about primary vs. secondary insurance



Recommended Posts

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:

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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:

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
      1 protein shake (bariatric advantage chocolate) with 8 oz of fat free milk 1 snack = 1 unjury protein shake (root beer) 1 protein shake (bariatric advantage orange cream) 1 snack = 1 unjury protein bar 1 protein shake (bariatric advantace orange cream or chocolate) 1 snack = 1 unjury protein soup (chicken) 3 servings of sugar free jello and popsicles throughout the day. 64 oz of water (I have flavor packets). Hot tea and coffee with splenda has been approved as well. Does anyone recommend anything for the next 3 weeks?
      · 1 reply
      1. NickelChip

        All I can tell you is that for me, it got easier after the first week. The hunger pains got less intense and I kind of got used to it and gave up torturing myself by thinking about food. But if you can, get anything tempting out of the house and avoid being around people who are eating. I sent my kids to my parents' house for two weeks so I wouldn't have to prepare meals I couldn't eat. After surgery, the hunger was totally gone.

    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

    • Sandra Austin Tx

      I’m 6 days post op as of today. I had the gastric bypass 
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×