Insurance Help!

Kimberlym145
on 11/28/15 5:14 pm

 My primary excludes surgery but my secondary covers it. HELP. PLEASE. What do I do?

(deactivated member)
on 11/28/15 5:44 pm, edited 11/28/15 11:21 am - CA

Generally, if the secondary ins covers the procedure, but primary does not the process is to submit to primary ins, get denial and submit the explanation of benefits to secondary ins so they can cover.  A couple of things to keep in mind.  

  1. Make sure that which ever surgeon you choose is in network with both carriers. 
  2. Make sure  the surgeon/center gets a prior authorization for your procedure  from the secondary insurance and files with that auth #. 
  3. You will still have to meet your deductibles and cover % of your procedure since only one carrier will pay. 

Try to find a center/surgeon who has an experienced insurance staff member who has dealt with dual coverage and you should be good.  

Best of luck to you. 

Kimberlym145
on 11/30/15 7:27 am

THANK YOU SO MUCH! 

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