Secondary Insurance Covers/Primary Doesn't

SunnysGran · 09-10-2006, 02:26 PM

Hi Everyone! This is my first post. I am interested in having LAP-BAND® Surgery. My primary insurance excluses WLS, specifically stating even with medical necessity

(Imagine that?!) But, my secondary insurance, which is with my husband's employer, does cover WLS. I wondered if anybody else out there knew of a similar situation? Will the secondary ins. balk at covering since the primary doesn't? I could drop my crummy ins. and only have my husband's, but I hate to do that because my employer pays 100%.

You guys are so helpful and supportive. I've been lurking for a couple of weeks and learned so much.

I went to a WLS seminar yesterday and it was great! Included was a fashion show of people who've lost most of their weight and it rocked! Very inspirational!

Thanks in advance for any help you can give.:)

**Alexandra** · 09-10-2006, 05:52 PM

Your secondary insurance doesn't care about your primary's exclusions. All it knows is what your primary didn't cover; the definition of secondary coverage is that it will handle claims you submit as long as you have already gotten whatever coverage your primary carrier provides.

It doesn't care WHY your primary carrier might have denied something, that's not its business. Your secondary insurance has its own contract it must follow, so if it says it will cover banding and you've already submitted the request to your primary and been denied, your secondary will have to cover it on its own. You may have to show proof that your primary denied the claim, but that won't have any effect on whether your secondary covers it or not.

Just because one carrier has an exclusion doesn't mean that exclusion carries over to the second. You're in great shape!!

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