I have Kaiser insurance as my primary through my job. I needed surgery with a particular out of network provider. I did consult with a KP surgeon but did not feel comfortable with their management of my disease. My KP docs advised me that KP will not approve an out of network provider for this surgery as they feel they can manage it. I ended up signing up with my husbands insurance, a PPO -Anthem, and had surgery in June 2020 with a provider in Anthems network. When I signed up for the insurance I was sure to ask the insurance broker hired by my husbands company if I would be able to use his benefit for surgery, outside of KP. She told me I wouldn’t even have to let them know about KP insurance because it’s an HMO and wouldn’t pay for the surgery. I didn’t get any explanation about primary vs secondary insurance. I assumed two insurances meant I had two types of coverage. So when I had surgery all of my claims were submitted to Anthem. They originally processed and approved the claims. I just received notification that the claims have been denied and have to be sent to primary insurance. Is there something I need to do? Do I contact the hospital and clinic and let them know to resubmit claims? Or does anthem do that? Is there any way anthem will reject all claims? I’ve heard timing is of the essence. Please advise. Thank you!
submitted by /u/SillyBilly2613
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I have Kaiser insurance as my primary through my job. I needed surgery with a particular out of network provider. I did consult with a KP surgeon but did not feel comfortable with their management of my disease. My KP docs advised me that KP will not approve an out of network provider for this surgery as they feel they can manage it. I ended up signing up with my husbands insurance, a PPO -Anthem, and had surgery in June 2020 with a provider in Anthems network. When I signed up for the insurance I was sure to ask the insurance broker hired by my husbands company if I would be able to use his benefit for surgery, outside of KP. She told me I wouldn’t even have to let them know about KP insurance because it’s an HMO and wouldn’t pay for the surgery. I didn’t get any explanation about primary vs secondary insurance. I assumed two insurances meant I had two types of coverage. So when I had surgery all of my claims were submitted to Anthem. They originally processed and approved the claims. I just received notification that the claims have been denied and have to be sent to primary insurance. Is there something I need to do? Do I contact the hospital and clinic and let them know to resubmit claims? Or does anthem do that? Is there any way anthem will reject all claims? I’ve heard timing is of the essence. Please advise. Thank you!
submitted by /u/SillyBilly2613 [link] [comments]Read Morer/HealthInsurance