Secondary insurance covered; primary - no

[hollywrites2u 15]

Hello all, has anyone had any luck with getting their secondary insurance to pay for their surgery when the primary doesn't cover it?

My employer provided healthcare insurance is Florida Blue & it sucks. There's an exclusion for everything related to bariatric surgery - no band, balloon, gastric bypass, sleeve, revision, or repair of previous surgeries.

My secondary insurance, BCBS Michigan, covers everything. It's a great plan and I hardly had to pay for anything when I got the lapband 20 years ago.

I've had trouble with the band & I want to get it removed. I would like to get a revision to a gastric bypass so I don't regain all the weight I lost. I've made some calls to surgeons & was told by one insurance coordinator that if my primary rejects paying for it then my secondary won't pay for it because that's "coordination of benefit". Arrrghh

I'm going to see a surgeon in a couple weeks. I haven't seen a bariatric doctor in 10 years (my bad). I had talked myself out of the fear of getting a revision to a bypass & now it seems that I can't get it. I'm so mad at my employer for providing minimal, crappy insurance & that having secondary insurance doesn't help at all.

Background: I'm 5'5 & 240 now. I was 5'6 & 315 in 2002 when I got the band. I got down to 195 but had saline removed 10 years ago after having some problems. Now I have GERD & some other issues.

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[liveaboard15 1,292]

I remember this same topic you posted a week ago. I replied on it. But yea its not just your employer. Its all of Florida blue and any medical plan from the healthcare.gov website. Many states they dont have to cover it so they dont. Which really sucks. I have thought about moving to a state that does cover it but that would be more trouble than its worth in my opinion lol But yea either start saving, or you can try getting a loan maybe? My hospital suggested a company called Prosper but getting a loan of over 20 grand sucks without collateral.

[hollywrites2u 15]

I read your comment. I appreciate you replying again. I posted here because I thought I might get more feedback in the insurance forum from someone who might have had luck working with their secondary insurance.

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[GradyCat 3,692]

I used to be an insurance adjuster, so I know a little bit about this. Secondary won't pay anything that primary doesn't cover. They just prorate the underlying coverage.

[hollywrites2u 15]

I used to be an insurance adjuster, so I know a little bit about this. Secondary won't pay anything that primary doesn't cover. They just prorate the underlying coverage.

It seems like that's the sad truth of it. One of the staff at a surgeons offive told me that my husband's DOB is before mine (April & I'm December) so his insurance could be considered primary & mine secondary. That made no sense to me. Lol

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[Famulenu 1]

Hi there! I'm so sorry to hear about the issues you're facing with your insurance coverage for your bariatric surgery. That must be really frustrating and disappointing. It sounds like you've had a tough time getting the help you need from your primary and secondary insurance providers. Have you considered reaching out to an insurance agent at thefinitygroup.com for help navigating this process and finding a solution that works for you? They may have experience working with insurance companies on similar cases and can offer guidance and support. I hope this helps, and I wish you all the best in finding a resolution.

Edited February 14, 2023 by Famulenu

[kla7403 48]

wait are you guys saying that if primary doesn't have bariatric coverage and the secondary does, that secondary wont cover it since primary denied it?