Help! What would you do?

Good morning all! I have recently started the process to go through WLS. However, I have two insurances. Aetna and MD medical insurance (Medicaid). So with Aetna I can possibly get approval within 4 months. But with Medicaid it takes 7. My surgeons coordinator recommended that I drop the Medicaid. Because their process takes longer, but I don't want the financial burden that I would incur as a result of dropping the secondary. Why would you do? Also, if anyone has had this issue what guidelines did you follow? The primary or secondary. I really don't want to wait until winter to do the surgery. Any suggestions would be appreciated!

Personally, I'd keep both insurances.  Who knows if other health issues might pop up - better safe than sorry.  Insurance is a tricky thing - during my pre-op process, I thought I had Medicare as primary and Fallon as a supplemental coverage.  It turns out Fallon is a Medicare replacement policy??  I'm still confused about it because Medicare still deducts money from my check every month.  I'd call Aetna and ask them what happens if you drop Medicaid - will they pay for WLS in full; what would your co-payment be.  I also spoke with the Financial Services office at the hospital - based on my income they waived my program fee ($300) and inpatient co-payment ($600).

Four months vs. seven months is not a big deal in the long run.  Follow the pre-op requirements for both insurers until you resolve the coverage issue.  I'm sure you're anxious to get the surgery done ASAP, but it's better to be safe than sorry when it comes to insurance issues.

Good luck.

I don't plan to drop the supplemental. I just think it's crazy I have to follow the secondary insurance guidelines when they only part is a small portion. 

I don't have any direct experience with this per se, but I wanted to let you know what  was told to me that might put things for you into perspective. Not sure how your program is, but this is just my 2 cents! Lol. I wouldn't do anything and keep both insurances here is why. 

I have Anthem BCBS PPO. My husband's insurance is fantastic, and I knew ahead of time I wouldn't have many hoops to jump in. 

The first time I met with the coordinator, she said ," Your surgery can be scheduled in a month! Get all your tests complete and you will be good to go." That was the end of Jan.

Well, I did. However, I didn't have surgery until last week! My surgeon is that backed up, and the clinic required a couple of things even though my insurance didn't! 

So, during that time I just got my head on straight. I read everything I could about the surgery etc. Your time will come! Just be patient! A couple of months seems like a long time, but really it's not. Good luck.

It's not too many hoops. Just getting followed by a dr for those months. However, I wish I had what you had. Lol seems great to just be approved. I feel like its 50/50 with either insurance. I'll be patient. Just didn't want surgery in the winter and seemingly it will be in the dead of winter by the time I get approval.

I don't think 7 months is that big of a deal.  You'll learn a lot and have many appointments during that time, so it'll pass pretty quickly and you'll be well prepared for post-op life.  Plus whatever weight you lose before surgery will mean that much less to lose after surgery.  

I was approved on my first request  for wls, took 2 weeks. I have Medicaid only. Maybe my heart history is why I was approved quickly..

Call your Medicaid coverage and ask if as a secondary they still require the 7 months OR if they will follow the primary plans guidelines.  It doesn't hurt to ask.  Sometimes (not all) the secondary will follow the primary guidelines.

I called and she said I still had to follow their guideline although they're my secondary. But in speaking with other people I'm kinda confused. A lady has the same insurances and she did 3mos. It's craziness. 

I don't have any direct experience with Medicaid. In MOST cases, the secondary insurance is required to pay if your primary insurance approves coverage and pays.