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.

So how does one find a COE?

i would think your insurance company could provide some help

I found it!

http://asmbs.org/member-search/

Can you have surgery at the place that is far away and then use your in town doc for followup?

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It maybe something I will have to investigate if my appeal is denied. I just really hate the idea of being that far away from the surgeon who preformed my surgery in case there are complications. That just adds a whole new layer of concern for me, especially since I will be having two surgeries at one time. All I can do right now is pray that they will approve me and if they don't then I will work on the next plan.

This will work for you. .. we are going to claim it. . when you first signed up for this WLS they should have informed you. .. my very first visit to see a surgeon to discuss this procedure I sat in the waiting room of course waiting to see the surgeon and as I walked back the receptionist stopped me and said. . your insurance requires a BDCOE and we are not? I said ok and left. . luckily there are at least 3 in my area within an hour drive but someone should have been able to give you that information before it got this far? Wishing you the best and please don't give up

patiently waiting

This may have been the way it went if I had gone to a surgeon in search of VSG, however I went to a surgeon because I had an open wound that had not healed for 8 months, at this appointment I was informed that I had a hernia mesh that was infected and needed to be removed and replaced with a biologic mesh which is less likely to become infected in the future however it is not as strong so if I do not reduce the pressure in my stomach (lose a lot of weight very rapidly) I will have a hernia through the replacement in just a few months. So it was either have a weight loss surgery or have multiple hernia repairs. In addition, even if informed I still would have pursued this direction because as stated before two fellow employees have been approved by this same insurance company to have surgery at the same hospital I would like to use. It is a center of excellence for surgery just not specifically for bariatric surgery.

Has anyone else won an appeal with their insurance company?