Medicare as Secondary Insurance

RhainyC
on 3/18/16 10:30 pm - Custer, WA

My primary insurance is Self Pay through my husband's employer and they have a specific exclusion for weightloss surgery.  Medicare is my secondary and I know that it will cover a D/S.

I am trying to figure out a way to get my surgery paid for and if Medicare will pay if the "Medical Necessity" for my surgery to my primary insurance fails to provide a one off approval.

Presently I have a 56.5 BMI and a bunch of comorbidities, along with already having needed two spinal surgeries, one, most assuredly is due to my weight.

 

Has anyone had any luck with this?

Cheers,

RhainyC

hollykim
on 3/19/16 2:16 pm - Nashville, TN
Revision on 03/18/15
On March 19, 2016 at 5:30 AM Pacific Time, RhainyC wrote:

My primary insurance is Self Pay through my husband's employer and they have a specific exclusion for weightloss surgery.  Medicare is my secondary and I know that it will cover a D/S.

I am trying to figure out a way to get my surgery paid for and if Medicare will pay if the "Medical Necessity" for my surgery to my primary insurance fails to provide a one off approval.

Presently I have a 56.5 BMI and a bunch of comorbidities, along with already having needed two spinal surgeries, one, most assuredly is due to my weight.

 

Has anyone had any luck with this?

Cheers,

RhainyC

if there is an exclusion on your primary policy, even "medical necessity" won't make them cover it. Your best bet is to go right on to your secondary.

 


          

 

RhainyC
on 4/17/16 11:22 pm - Custer, WA

Hollykim,

 

Thanks for the suggestion.  I am hoping to push them into changing the policy due to numerous severe comorbidities.  My husband's company is Self Insured, and I plan to throw a lot of stats at them that it would save them money in the long run to allow it for me at least...I've already had 2 spinal surgeries, and need a 3rd, as well as a knee replacement which may possibly be put off IF I were to lose the 200 pounds I am over my ideal.

 

Cheers,

RhainyC

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