Does anyone have experience with Medicare covering WLS after a primary has denied...

We have a good news, maybe bad news scenario.

I had RNY this past summer and because I was totally disabled my Medicare Advantage plan through UnitedHealthcare covered the lions share of it. My husband had also been totally disabled, but has been able to return to work. He is now insured under his work policy with a company that has more than 100 employees ... that's only important from a medicare coverage perspective. At any rate, his new employer has a specific exclusion for anything related to morbid obesity, which of course includes any WLS ... short-sited in my humble opinion, but it the it is for now. Because of this exclusion, there is no way that his primary carrier, UnitedHealthcare will approve the surgery. I wasn't worried, because I knew that the Medicare Advantage plan would cover it. So, I called the Dr's office with a question and mentioned the coverage issues, they said that Medicare follows suit after the primary. Meaning that if the primary denies for any reason, Medicare denies. I called Medicare and they said, no if it is considered medically necessary and meets the determination criteria that they will cover if the primary doesn't cover. That it has to be submitted to the primary and that the primary has to deny the coverage, that the denial has to be appealed, but following the appeal, if the primary doesn't cover, then Medicare Advantage/Secure Horizons by UnitedHealthcare would cover ... So, what's up? Do you know of any instance when Medicare has paid when they are the secondard carrier?

Does anyone have experience with Medicare covering WLS after a primary has denied coverage?

I'd appreciate any input you might have. I would like for my husband to share the good health that I'm now enjoying.

Thanks,

Barb