Center of Excellence stipulation ?

[Dub 10,070]

Anyone else have their insurance state they must have their surgery done in a facility that is a "Center of Excellence " ?

UHC has this written in the benefit guidelines for coverage of weight loss surgery.

The facility I'm going through does not have this accreditation yet. They may by the time my surgery date comes around but they may not.

I'm really sold on my surgeon and want to proceed with this location.

Just hoping I can get around the requirement.

Any experience with this ?

[Djmohr 6,965]

Yes. My insurance company Medica required it and for me there was no getting around it if I wanted it covered.

I too had started with a doctor that was not a part of a center of excellence and had to switch. I will say I am very happy that I did because of the enormous care system put in place by my center of excellence. For me I think it was a blessing. So much so that I have moved states and insurance companies and bought insurance that has my center of excellence in another state covered in network. I just did not want to change because they are so good. So now, I drive 6 hours for an appointment but am thrilled with the care and level of service I get because they are a center of excellence.

Some of the benefits for me were: a team of bariatric specialists who many have gone through this surgery themselves. I have a nurse assigned to me and she herself had bypass 14 years ago, my nutritionist, psychologist, bariatrician and surgeon are all right there in the clinic and speak to one another.

. The clinic is set up for bariatric patients in a way that makes it more comfortable. Larger chairs, examine rooms, equipment.

Even the hospital where they performed my surgery. They have a bariatric wing, each bariatric suite private. I was shocked how well I was treated and how comfortable they made me.

I am not sure if they are all like that but I know they had to earn their status.

I hope things work out for you and you are able to work through it in a way that makes you happy.

[kbmerritt84 4]

Yup, Cigna requires it too.

My surgeon works at 3 different hospitals so I was lucky enough to be able to keep him.

To be honest, you want to have it done at a center for excellence if possible. there are very rigorous rules to gain that qualification and if you do, then it means that you are in a good hospital with an experienced team with low complication rates.

[Geron Girls 70]

I have UHC as well and they do require me to use a BCOE. I'm ok with that because it means they really have to meet stringent guidelines to qualify as a BCOE. And they have to do it every year.

[tstarkey704 21]

I have Cigna also and they required COE as well.

[Sajijoma 1,324]

My plan is Aetna and they prefer at Center of Excellence but will pay at a greatly reduced rate for a non center of excellence per my plan(it varies so check your plan specifically). So basically, I'd pay more out of pocket for less assurance (in theory) that my surgeon is capable, culpable, and able to meet my needs. That's how I look at it. I chose a center of excellence because I want to know that I'm getting the best for my money and hopefully can avoid un wanted complications from a less experienced surgeon.