Hello All!

Happy New Year!

With the New Year, I am sure that everyone is looking forward to a new beginning and future as am I!

The issue that I am having is trying to get a straight answer from my Insurance Company (ies) regarding who is the primary payer on any medical procedure, device, or medication that I have prescribed to me by a doctor.

I’ve finally made a decision to have the vertical sleeve done by Banner Gateway MC in Gilbert, AZ. I think that will be the best option for me in the long term. What has me even more excited is the Idea that it is a covered benefit thru the Insurance provided thru my company, United Healthcare, and thru my wife’s Insurance, Banner Health, but with way more hoops to jump thru.

I want this done sooner than later, and I have all the documentation that the Insurance companies want to prove the medical need for the surgery, but I don’t think anything has been covered by my United Health as the primary, It’s always listed on the bill summaries as the secondary insurance.

My wife says (who is a nurse for Banner) that it goes by who’s (the Insured) birthday is first in the year, both policies say that the Primary insurance is the policy holder in the instance of dual coverage.

Can ANYONE please shed some light on this?

Thanks,

Phillip

You are both right. Usually each person has themselves as the primary on their own policy and the spouses insurance as secondary. In the case of whose birthday is first only applies if you both have "the same" insurance company.

I wouldn't put too much stress in figuring it out for yourself. The insurance companies will work it out between themselves if there is any question. Once the decision is made, one company will pay 80% and the other company will pick up the 20% if both companies pay for WLS.

If only one company pays for WLS it will be covered at 80% and the other will not pay any.

This is the norm in most cases. I would put yours as primary when you have the staff submit for a pre-determination of benefits.

Phillip

I work in Medical insurance billing and the birthday rule you noted is only for children dependants of two adults with insurance. As the employee your insurance will be primary and you wife's insurance secondary for you and for her it would be her insurance prime and yours as her secondary.

If you are getting a statement from a hospital or doctor listing your UHC as secondary, I would call them and let them know it is listed backwards.

Hope this helps and good luck

Patti