Frustrated!!! Insurance companies aren't my friend!

So I had RNY Jan.2010.  The insurance process with Blue Cross for myself was a piece of cake.

My husband however is currently going through the process himself.  We just received a phone call from one of our doctors saying that Blue Cross is asking for their money back after they had already paid an insurance claim, due to the fact that they are his secondary and United Healthcare Choice is his primary.  Well UHC is TERRIBLE!  Not many doctor's here in NY take that insurance and the one's that do are yahoos! 

Anyhow, will he still be able to have the WLS through his secondary BCBS?  The surgeon we are going through only takes BCBS and not UHC.

Any thoughts would be appreciated!

We are just in the beginning stages...

Hang in there...there should be a way to work this out.  The typical process is that your practice will have to submit a bill to United and get a denial from them and once they have that in place, they should be able to turn around and submit to BCBS for coverage.  HOpefully your surgeon's team can provide you with some assistance to get this done.  I hope this helps and don't give up hope!  Good luck to both you and your husband!
Warm Regards,
Kim

You must go through United first. Secondary does not have to pay anything primary does not. Secondary will only pay the balance of primary. If primary does not cover secondary will not either.

Actually this is not necessarily true.  For most commerical coverages, the secondary can (and usually does) will pay for services that are denied by the primary as non covered.  they simpley use COB (co-ordination of benefit) rules that are normally dicated by state mandates (if your employer is subject to those), or by the group contract.  There are various methods of calculation of secondary payments.  With the exception of Medicare Supplemental the covered services under secondary are not dictated by the covered services under primary - with one major exception.

The exception is some contracts specifically exclude charages that were not paid by the primary coverage due to failure to follow the primary carriers UM (Utilization Management) criteria.   Whether ot not this is allowed in your state depends on the state, and if the employer contract is subject to state mandates.

Some contracts waive UM requirements when secondary (but not medical policy decisions), but others do not.  And the amount of money paid under a secondary doe snot mean you have no liablity.  Some COB methods (if permitted by applicable law) mandate that the patient have the same overall liablity if secondary and is primary (example - you have a primary copay of $150.00 and a secondary copay of $250.00 on inpatient admit, the secondary would not pay anything.  The idea is an employee with 2 coverages doesn't get any more of the dollars paid than if the employee had only one coverage.

Sorry to be so long winded :)

This has not been my experience when filing for patient services.  Most secondary ins policies only pay if primary pays first, 2nd ins pays the balance of what primary pays.