Insurance question

Hello,  I am having surgery and I have an insurance question. I have a primary insurance and a secondary insurance. The primary denied my surgery, but the secondary approved my surgery. I am afraid that come surgery time, the 29th of this month, somebody will say "I'm sorry, but your primary had to approve your surgery and now you can't have surgery". Can anybody adivse me on this?

EM

Your secondary approving it should have nothing to do with it; it just means that you have 2 insurance companies.  For example, with 2 insurance companies say you have a doctor's visit that costs $100.  Individually, they would probably pay for the whole thing, but if you file with a primary and then a secondary, the primary might pay $50 and then the secondary would pay $50 (as opposed to paying the $100 that they normally would if you didnt have another insurance) They do this to keep you from getting more money out of them (ie if the secondary paid the whole $100, you would have a credit of $50).  So....all that being said, since your primary denied it, your secondary will be footing the bill as if they are your only insurance provider (since you wont be able to file your primary, considering they arent paying anything). Hope this helps and I didnt confuse you! Lol  GOOD LUCK!!!!

EM, since your primary denied the surgery and the secondary approved it then that is fine.  They will pay according the benefits set forth through your secondary insurance.   As far as the other poster responding,  when 2 insurances are involved they do what they call COB coordination of benefits.   The primary will pay the usual and customary, then its sent to the secondary insurance and they coordinate with the primary insurance.   However if the primary paid over and above the allowed amount the secondary would pay then the 2nd insurance would not pay anything.  But your main concern right now to answer your question is you are fine.  They will not resend on the approval

Vicki

Vicki,


That's my middle name by the way. Great name. Anyway, I really appreciate everybody's input. I guess I am so nervous about this surgery. I am so afraid that somehow something's going to happen and I won't be able to get the surgery that I need. I guess I won't be relaxed until I'm in the recovery room! Well if anybody else has any advice they can give me, I would really appreciate it.

Hi, as long as your secondary approve the procedure, you are fine.  The office and hospital will have to get a denial from the primary to bill the claim to the secondary.  It is kinda like you only have one insurance, you will be responsible for any co-pays or deductibles that are not covered under your plan.. I know, cause I work in the bariatric world of authorizations.  This is my primary job.  Hope this helps.  If you have any questions, please let me know. Thanks

Thanks so much for your reply. It really does put me at ease.