Having two Insurances compaines UGH!!!

I have Medicare and FEP Blue Cross. The way my insurance works is Medicare will pay their 80% and my other insurance picks up the balance. I know what the requirements are for Medicare. I was talking with FEPBCBS today I told them I had to meet Medicare's requirements before they would pay, I then asked since BCBS will be picking up the rest of the bill do I also have to meet their requirements too. There is just a little difference and one of them I may not have.(because I don't think that the doctor took great notes). They told me yes I have to meet their requirements also. I just thought what ever Medicare didn't pay the other would since that is what they always have done. So now I have to satisfy two companies. UGH! If I don't then it will end up costing me about as much as it would to go to Mexico. I hoping the girl at the clinic tells me that the one I talked to on the phone doesn't know what she is talking about. Might be wishful thinking I hope not.

What does "one of them I may not have" mean??  Need details!

sorry,  I didn't seen much of my PCP last year so I have to rely on my heart doc. The requirement that I might not have is evidence of a attempt at weight loss one year prior to surgery.  I did loose weight but unless my heart doctor documented it I will have to wait even longer. He doesn't seem like he writes many notes.  He does it while I am sitting there in his office. But I look at it this way. His nurse puts my weight in my chart when I see him and if that counts then I will make the requirement if not then I will have to wait. I look at it like this I've waited this long I can wait a little longer even if it is months. Must have a positive attitude. Sometimes I just need to vent I guess.

Insurance is complicated.  The first question that needs to be answered is who is the primary payor for your procedure?  Those generally are the rules that you must follow.  The second plan generally honors the primary payor's rules.  Federal regulations determine when Medicare is the primary payor and when it is the secondary payor when your are covered by more than one insurance policy.  You need to know this.  If Medicare is primary, and you qualify though them, FEPBCBS should accept that and pay in the secondarr position without you having to qualify through them.  If FEPBCBS is the primary payor, then you must meet their criteria, and Medicare should follow in the secondary position.  Good luck

Maryann

That's what I thought too. And so far that is how it has been with all other medical bills. However when I talked with FBCBS yesterday the girl said hold on I don't want to give you the wrong advice let me check with my supervisor and when she came back to the phone she said even though they are my secondary insurance I still will have to complete all of their requirements too. But I'm hoping when I go for my first appointment (since they deal with insurance companies all the time) they might have a better insight on things. For all I know the girl could have just said she talked to her supervisor and didn't.

I have the same issue re the weight loss/diet requirement.  I drafted a letter and brought it to my doctor, explaining the situation.  He has been very supportive of WLS and has been recommending it to me all along.  The letter basically stated that when I was seeing him regularly a year and a half ago I weighed 380 pounds; I've been seeing him monthly (since 8/12) and have gone down to 316.  He basically entered what I said on his computer and had his secretary put it in "final form" - I had him send a copy to the Weight Center so it will go in with my paperwork next week.  I'll update you as soon as I hear from the insurance company.  Surgeon's office thinks it will do the trick. If it's denied, I'll appeal because I have lost a significant amount of weight, and isn't losing weight the purpose of the supervised diet? 

Have you spoken to the "Insurance Person" at the surgeon's office?  She may be familiar with the situation you're in.

Good luck.

I hope things work out for you and the insurance company will accept your letter. As far as I go my PCP wants me to wait until my first appointment to start my 6 month weight loss because she said she never heard of a PCP supervising the diet. (But she would) if she had to. So I will wait. I waited this long a little more time I can handle. Won't like it much but I can handle it.