Revision and double insured?

I was wondering if my primary insurance, which is Blue Cross Blue Sheild of Iowa(Wellmark Blue Access) through my employer.  Weight loss surgery is covered, with prior approval.  I also have Iowa Medicaid secondary, they say covered if medically necessary and that is if the doctor says it is medically necessary. So my question is what if BCBS denies, will or can Medicaid approve?   It would be a revision due to weight gain and hypoglycemia. Thanks Kourtney

Typically, with coordination of benefits (being covered under two insurance plans), the secondary would follow the coverage rules of the primary though that's not always the case. Basically, Blue Cross/Blue Shield's prior authorization is a certification that the surgery is deemed medically necessary. If the surgery is approved through your primary carrier, then you want to take all the approval paperwork and medical documentation and submit it to your secondary carrier for approval as well. If you present sufficient documentation, your secondary carrier should be able to cover any remaining financial responsibility that you would incur from the first approval. In other words, if you are approved under your primary carrier and your benefits state that you will have a $100 co-pay for inpatient hospital stay, pending the approval of the surgery by your secondary carrier, you can submit that $100 co-pay claim to the secondary for coverage.

If, however, you are denied by your primary carrier, there is still the possibility that your secondary carrier could cover the procedures. It depends on what is indicated in your explanation of coverage regarding coordination of benefits. For some health insurance companies, if they are secondary and your primary denies the procedure, they might deny it as well. Consult your explanation of coverage, or contact the customer support department of your secondary carrier to find out the specific rules regarding coordination of benefits.