Insurance And Center Of Excellence

[malia247 3]

So my insurance denied me back in July 2012 because the hospital I'm going through for the VSG is not a Center of Excellence (COE) The hospital finally got certified as a COE in September 2012 so I'm thinking e a getting closer. Great news right? Wrong! Now the insurance is having the hospital go through a contracts process which was only supposed to take a few weeks. So I spoke to the hospital this past week and they won't be finalized with the contracts process until late January or early February 2013. By then I would have waited 7-8 months since the initial consultation. The hodpita did say that they are working with the "blue" insurances to see if they'd be willing to pre-authorize a few patients including me pending COE finalizations prior to the January/February date. Crossing fingers the insurance pre-approves those of us waiting patiently. I'm so anxious to get this procedure done. My quality of life is awful and I live with a great deal of joint pain due to my obesity. I pray the insurance will expedite the process. If not, I'll continue to wait but it's getting frustrating. Thanks for listening....

[slimagainsoon 88]

There got to be other hostipals that are Blue Center of Excellence!! Noway, would I wait. I have Bcbs and when I called them they gave me a list of 7 hostipals that was within 25 miles of my surgeon office. By waiting until next year, want you have to meet 2013 deductible? I have to get my sleeve this year because I have meet minds. I am waiting to hear about my approval sometimes next week.If not I would have to pay the surgery out of my pocket. You may have a longer commute if you fine another hostipal, but it will so be worth it. Good luck, I hope it will be sooner then later for you.

[MrsDwD 12]

This website has a list on Accredited, participating Bariatric Surgery Programs. The accreditation is through ASMBS BSCOE (Center of Excellence).

Http://www.acsbscn.org/Public/Centers.jsp

Hope this is helpful!

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[malia247 3]

Thanks for the responses. There certainly are hospitals that are COE, but then I would have to start the consultation process over again. My PCP is at this particular hospital and I fear it'll take just as long to start the process over at a COE hospital than to just stick it out with the existing hospital. Arrgh! I have waited this long and I'm praying the approval occurs soon. I pray the Lord makes it happen but if not, perhaps this is how it's supposed to be. I've waited this long and if I need to wait a few more, I look at it as God feels it's not time for mecto go through this journey yet. Anyways, thanks so much for the thoughtful responses and support. Keep me in your prayers and hope for a great outcome. Crossing fingers I hear that the hospital gets a pre-approval soon....

[MrsDwD 12]

You are right, it's probably best to hang in there b/c any other Bariatric program will have you start over from scratch with them! Stay on em'.

I started the process back in June 2012; my clinic was sitting on my file after my last appointment 10/12/12....they had not sent in the paperwork to request authorization....I kept calling every day or so to hound them and finally they submitted the pre-auth document by fax on Thursday ( 11/8/12), and to my surprise I got the call from the clinic yesterday (11/9/12) with the approval!!! I was a little ticked b/c with the quick approval turn around I probably would've been sleeved by now....but I am just as excited that I will be sleeved in December 2012!!

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[Di-Sleeve 8]

Hi Malia,

I have BCBS as well and had a VERY difficult time with them to get approved. I ended up changing hospitals once and feared I would have to do the entire process over again and I didn't. The only thing the new hospital made me do was go to their seminar. After I had attended their seminar I made an appointment the next day with the surgeon and in less than two weeks my surgery was scheduled. I started my process end of Jan 2012 and just got my sleeve on Nov 5th. It was a VERY long process that I almost gave up on.

Just my advice, call a second hospital and simply ask how they can help? Maybe you're closer than you think! Good Luck!

[malia247 3]

Wow that's great news! I think I'll call another hospital to see how soon they can help. I just hope they don't make me go through the process again but it looks like you had luck so hopefully I can too;) thanks for the great advice!! Glad you were able to get it expedited. Take care!!

[Di-Sleeve 8]

Yea no problem!! I said to myself if I have to do these 6 months again I'm not doing it. Lol

The doctor told me that as long as I had a copy of all the clearances from the doctors I saw and their information he'd accept it. I'm a freak of organization so I had like 3 copies of each but if you don't you can simply ask your current hospital for a copy of your chart and they'll release it to you.

By the way, the new hospital even required a separate psych evaluation of their own (worth $150) and after I showed him that I even had that done he gave me an ok and I didn't have to do it.

Again, just call and ask. Doesn't hurt. And as a previous comment said the insurance will "love" to push it until next year so that way you have to reach your out of pocket cost. Don't let everything you've done now go to waste. : )

The things we need to do to!!! Lol

[malia247 3]

So I checked another hospital in my area and inquired about getting surgery done potentially at their bariatric center. Unfortunately their advice was to just stick it out at the existing hospital as their schedule is such that by the time I attend orientation, meet with surgeon, etc., etc., the surgery date will be the same as where I'm at, end of January, early February. I have to say it's frustrating but I keep thinking maybe this is God's will and I'm just meant to have the VSG in early 2013? I mean after all it is a major surgery and maybe this is how it's supposed to be? Either way, I am staying patient and praying the surgery comes as soon as it is meant to. I'll keep y'all posted. Started the process June 6, 2012 and counting. Wish me luck, prayers welcome as well:)