Today my application for the sleeve was denied because the hospital I am going to have surgery in is not a center of excellence. I live over 350 miles from one and I feel it would be incredible difficult on me and my family to travel that far for surgery and for follow-up. To add to this I will be having an infected hernia mesh removed and replaced at the same time so I really would like to be close to my doctor for my recovery. Has anyone else had this problem? I submitted an appeal which I requested to have expedited but it will still be 10 to 14 business days. I am so worried they are going to deny it again.

Im very sorry to hear that, but most hospitals have a family house you can stay in almost for free, if cost is a factor. Even though my doctor is only 2.5 hours away I was scared to leave the hospital. Stayed in a hotel for a night just in case. I hope you don't let this discourage you. Have you tried to call and speak with a claims representative and tell them how far you would have to travel.

My insurance will only approve it being done at a Center of Excellence as well.

It would be a six hour drive for us. In addition to just the distance and the inconveniece of driving that far not only for surgery but once a month for follow-ups for a year, I have small children at home. I do not want to spend extra time away from them anymore than I have to be. The only reason my hospital is not a Center of Excellence is because it does not do over 100 bariactic surgeries a year. Otherwise it meets every requirement. I should be able to get the medical care I need where I live.

I hate to say it but if your insurance requires a center of excellence then they will most likely deny it again. my insurance also requires a center of excellence and wont do it any other way. A lot of insurance these days that do cover this require center of excellence.

You should see if the hospital that you are going to has been registered as a center of excellence most recently; and perhaps they have not been recognized as one yet with your insurance company. Or ask if they are in the process of meeting these standards of "excellence".

I work for a healthcare organization and I know that based on Quality of Care reports that are currently being implemented across the country; that your hospital choice may be waiting for State Health reporting. Just a thought. I know that the direction of healthcare is to get all hospitals on board with "Center for Excellence"

They have applied and they have meet every requirement except the number of surgeries per year. They are required to perform 100 a year to be called a center of excellence however we just are not a very densely populated area.

Considering the closet COE hospital is hours & miles away, they just may grant an exception if that's explained in your appeal. So don't lose hope. Good luck & keep us posted.

I am hoping so. I included in my appeal the impact traveling would have on my family, my employer, and my recovery. I also included the really cost impact to them as well as me if I have a hernia repair without the WLS. My surgeon estimates without it I will have another hernia within 6 months of having the infected mesh replaced. My last point was that two fellow co-workers received approval to have surgery at this exactly hospital this year (they had began their visits to the surgeon before we changed insurance on January 1st-no approval but they had started their visits). My thought is that if the hospital was acceptable for their surgeries it should be acceptable for mine.

Don't give up, keep fighting!

How do you figure out where a COE is? Is there an online listing or something?

This link should help you find one: http://www.surgicalreview.org/locate/

Wow. I hope my insurance doesn't require a COE, since the nearest one is 8 hours away! There are only 12 in the entire US!

I think that maybe an old list. It doesn't have any showing in South Dakota, which I know is incorrect. There are two however they are 350 miles away from me. I would say go into your insurance website, there should be a location that will list all of the requirements for getting approval. I knew this part would be a little bit of a fight but I am hoping they will be able to see a patients point of view and the impact traveling this type of distance can have on the surgery and recovery.

There can't be only 12 in the U.S......there are at least two near me that I know of. One is 30 min away and another one just over an hour away

Wow. I hope my insurance doesn't require a COE' date=' since the nearest one is 8 hours away! There are only 12 in the entire US![/quote']

That is an old list then or a list for just your state. California alone has more than 12 COE. My state has around 10 itself.