Need Your Help Understanding . . .

I'm scheduled for surgery at the end of the month. I have two insurance companies. One is with my employer which I've learned it's considered my primary. Also through my husband's job. I was approved for the surgery with my husband's insurance and my surgery was set due to that letter BUT I just got a letter from Cigna (which is my primary) denying the surgery because I need to have a 6 consecutive monthly weigh-ins. The office manager at the Drs. office states that I'm still scheduled for surgery at the end of the month because my secondary approved me and she got a denial letter from my primary BUT to me this isn't a denial letter because the letter from Cigna states: After review of the clinical documentation submitted, medical necessity for this request has NOT been established because the following criteria was not met: 6 consecutive monthly weigh-ins. I guess my quesiton is do I have to start over and do the 6 month diet plan and then get a denial letter or is Office Manager correct this letter is good enough? Bottom-line I don't want to end up with a bunch of bills that I can't afford and put us in financial ruin. Your thoughts on this is greatly appreciated! I so want to have my surgery at the end of the month so I pray to God someone can help me understand.

Jean I would call the insurance company for clarification. I would also call your secondary insurance to find out how much you may be responsible for . -Jenn

Jean , I Had the same thing happen to me . I had insurance , and my x husband had insurance. My ins wanted 6 mo diet supervised . His approved right away . My bills where covered under his insurance all the way 100 % . Not being an insurane person and only able to give you my situation , I would call your husbands insurance , and make sure you are approved and covered . Then go rest your weary head . I know it will all work out and I know how frustrating this can be . HUgs, Natalie

Hey Jean, Dunno if me posting this is any assurance whatsoever, but my understanding of primary vs. secondary insurance is that when the primary doesn't cover, the secondary kicks in. In this cir****tance, I would ASSUME the secondary would cover the surgery, minus any applicable co-pays/co-shares. Wouldn't hurt to place a call to the secondary to confirm, though, for peace of mind. You'll know where you stand for sure, then. I know me, however, and I'd be taking it with a flying leap, and dealing with the aftermath later LOL.. but I'm not always the most financially sensible one in the bunch! Best of luck, Wendy