Kind of Bummed!

[maudeispam 2]

Okay so here's the story. I am scheduled for surgery tomorrow morning at 8am. My surgeons office calls me yesterday evening around 5pm at work and tells me they have the wrong insurance listed for my Primary. I have Wellmark Blue Cross and Blue Shield and Dakotacare. Wellmark is my primary. Dakotacare agreed to cover the lap band procedure no argument. Well now the surgeon's office tells me that Wellmark denied the claim or whatever and now Dakotacare may not cover either because they(Dakotacare) is my secondary insurance! Dakotacare may refuse to cover because my Wellmark refused to cover the procedure. The surgeon's office is waiting on a call back from Dakotacare to see what they say. I may have to put my surgery on hold or cancel all together! You would think with two insurance companies covering me there wouldn't be an argument! I also have a letter from Dakotacare stating they will cover the cost of the surgery and my hospital stay. I dont see where the big beef is. I have met my deductables, did the testing and everything, I think Dakotacare should pick up the bill. What are your thoughts? Please keep me in your thoughts and prayers! God knows I really want this and NEED this procedure!

[HotLikeHer 0]

I understood that 2nd insurance is to cover what your 1st doesnt, so If your first isnt covering the surgery I would think (I HOPE) that your 2nd will.

I hope all goes well for you........

[maudeispam 2]

Thanks! Thats what I was thinking too. Whats the sense of having two good insurance companies if neither are going to pay? I can see Wellmark won't pay because they do not cover the Adjustable Lap Band, but I feel Dakotacare said they would cover it and they shouldn't back out. JMO

[StartingOver 6]

Pam,

I don't think that your secondary can now deny a service that they approved, or that is written as a covered item in the policy, it shouldn't matter that you have another insurance plan that is primary. They may however, want proof that the primary is not covering it, just so that the claims can be sent directly to the secondary without them sending them back to the primary to pay first.

I'm sure it will all work out. I'm thinking good thoughts for you.

[maudeispam 2]

Thanks Corinne. I am still waiting patiently to hear back. I wish they would just call and give me the GOOD news!

[maudeispam 2]

Dakotacare accepted the claim or whatever. I am ON for surgery tomorrow morning!!! YEAH!! Dakotacare said I would have out of pocket cost of around $1750.00...but heck that is ALOT better than $25,000! Thanks for all the well wishes and PLEASE keep me in your thoughts and prayers tomorrow morning! GOD IS SO VERY GOOD!

[StartingOver 6]

Congratulations Pam. You are in my prays. Come check in when you're feeling up to it after surgery.