I have BCBS Health Select as my primary insurance. I also have Medicare from social security disability. When I started receiving Medicare I had the part B dropped to try and save some money since I had that coverage through my husband's employer. I cannot sign back up for part B until next year.
I have the BCBS EoC and it does state that they will cover the employee(husband), but not the dependant(me) for bariatric surgery.
In the beginning I thought I had done my homework. I had expected BCBS to pay for the bariatric doctor's office visits, which I have been pre-authorized for and they have paid in the past, and had expected that Medicare would pay for the hospitalization and procedure itself. Nothing I had read nor anyone I had talked to, had mentioned anything about the secondary insurance denying if the primary insurance denies.
I now know that, since BCBS will deny the procedure, Medicare will not cover it since they are the secondary insurer. I had the idea of switching to an advantage plan mentioned to me however, you have to be enrolled in both part A&B to do that.
I have several health issues that would benefit from having bariatric surgery. I have asked both insurances if there were any way to appeal based on significant health problems. A representative from both have told me that I'd have to wait until after I had the procedure done, and was denied, before I could appeal. That doesn't seem quite right, but what do I know!
I have been waiting two years for my Medicare to kick in to finally have this surgery so I could finally have my hip replacement just to realize that it might not actually happen. Hopefully I've explained this adequately enough. I'm about at my wits end and feel absolutely defeated!
I have the BCBS EoC and it does state that they will cover the employee(husband), but not the dependant(me) for bariatric surgery.
In the beginning I thought I had done my homework. I had expected BCBS to pay for the bariatric doctor's office visits, which I have been pre-authorized for and they have paid in the past, and had expected that Medicare would pay for the hospitalization and procedure itself. Nothing I had read nor anyone I had talked to, had mentioned anything about the secondary insurance denying if the primary insurance denies.
I now know that, since BCBS will deny the procedure, Medicare will not cover it since they are the secondary insurer. I had the idea of switching to an advantage plan mentioned to me however, you have to be enrolled in both part A&B to do that.
I have several health issues that would benefit from having bariatric surgery. I have asked both insurances if there were any way to appeal based on significant health problems. A representative from both have told me that I'd have to wait until after I had the procedure done, and was denied, before I could appeal. That doesn't seem quite right, but what do I know!
I have been waiting two years for my Medicare to kick in to finally have this surgery so I could finally have my hip replacement just to realize that it might not actually happen. Hopefully I've explained this adequately enough. I'm about at my wits end and feel absolutely defeated!
