Would a secondary (private) insurance follow a denial issued by the primary (private) insurance?
I have a question about whether a secondary (private) insurance would follow a denial issued by the primary (private) insurance, and if that's standard operating procedure when it comes to individuals with 2 private insurances coverages. My mom told me something and I don't think it's correct.
I have a Cigna plan through my employer, and Cigna is garbage. It doesn't cover Procedure Code 123 for Diagnosis code 456. So I'm considering getting an individual Aetna plan than I would pay for myself. Aetna does cover Procedure Code 123 for Diagnosis 456. It would be expensive to shell out for an individual plan, but ENORMOUSLY less expensive than how much it would cost to get this procedure done out-of-pocket or after Cigna's denial. Obviously, in this case, the Cigna would be primary and the Aetna would be secondary, since the Cigna is through my employer.
Here's my question: if/when I get this procedure done, it will have to go through my primary insurance, Cigna, first, and Cigna will deny because, again, garbage. Then it will fall to my secondary, Aetna. Will Aetna deny just because Cigna denies, the same way that Medicare secondaries will deny a CPT code if Medicare denies it?? My mom is absolutely insistent that if this claim hits the primary Cigna and Cigna denies, Aetna will follow suit, even though Aetna pays for the CPT code that Cigna does not pay for.
Is this correct? Would purchasing an individual Aetna plan to pay out for this procedure that I'm trying to get be a waste of time/money? Cigna would definitely deny because they don't cover the CPT code for my particular diagnosis code, but Aetna does–so wouldn't it make sense to get an Aetna plan so I can get the procedure done?
Hopefully that made sense; sorry for the rant. This is definitely not what I want to be doing with my Sunday but god, here we are.
submitted by /u/empty-health-bar
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