Insurance question....

Anyone....Well I got a decline letter from my primary but my secondary insurance approved my  RUnY and I am assured that with the letter that my secondary will pick it up..I even called my secondary and they told me the same thing...I am all ready with testing and all and have my date and just waiting for the pre-certification phone call which tells me how long they will approve my hospital stay..has this happen to anyone on this site?..good or bad please share with me..I am almost ready to cash out my 401K to pay for the surgery...Thanks for your reply..God Bless you..Linda

Linda, It didn't happened to me for the RNY but it did to my husband for an artificial cornea transplant. Anthem, his primary, denied it because they considered it experimental. Social Security Disability medical (Medicaid or Medicare..I always get the two mixed up) approved it all except the artificial cornea itself (~$10,000). They didn't want any money down and said to just wait and pay what the insurance doesn't pick up. Bill had the surgery last December. As per protocol, all the billing has to be sent to the primary first...twice. After it is denied twice, then the secondary will pick up the tab. So far, Anthem..the primary...has PAID for everything when it was sent through the 2nd time! We haven't seen the billing yet for the artificial cornea so we don't know yet if that will still be an out-of-pocket or not. I know many insurance companies are different in how they handle things but if I had the money in my 401 and got an approval by either my primary OR my secondary, I'd be getting my surgery scheduled! I would find out why the primary denied you and appeal it if possible. Sherri

My husband's insurance would not pay for anything for our gastric by passes but my insurance paid.  My insurance covers a procedure if the other party's primary insurance will not.  We lucked out.  Good luck.  Things will work out!