Question:
If primary insur says no and secondary insur says yes, will WLS be covered?
can someone help me with this please? o.k. can someone help me please. i have primary and secondary insuracne well primary flat out sais no. but secondary does have wls if medically nec. well mine is. it should get approval however they said primary would have to deny. well i told them i have it they said they would have to deny it after surgery. is this normal. has anyone heard of this? does that mean i will be able to have surery? any input would help. — enriqueta C. (posted on April 16, 2001)
April 16, 2001
That sounds strange to me. I am in the same boat with you. Primary has
exclusion, secondary will cover. Secondary doesn't know about primary,
though. I am wondering how they found this out. Also, if they will cover
after surgery after you have been denied, isn't that ok? Or are you afraid
they won't agree to pay and you will be stuck with the bill? Also, I would
keep prying information. Call and talk to the insurance company and get
whoever it takes on the phone to explain to you the situation and any way
to get around it. Good Luck!
— Tiffany_B.
April 16, 2001
Its simple.. if your primary insurance wont cover this.. submit the auth
request and have them deny it in writting.. hence.. you have your proof its
not covered and then submit the auth request to your seconday along w/ the
copy of the denial from the primary and you are done. This is standard
with insurance companies. When you have more than one the primary has to
process first whether it be payment or denial.
— Dawn R.
April 16, 2001
well i have denial letter from primary. i let them know all that. they said
it still has to be denied by primary. this is all so confusing to me.. i
just want them to say o.k. we will pay.. is that so much to ask for? just a
thought ..or are they going to wait for the bills and have primary deny
before they will pay? well thanks for all your advise. sincerely queta
— enriqueta C.
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