I' m so upset. My surgery was scheduled for Nov.9 but I received a call this morning that it has to be cancelled. Per my doctor's office, my insurance company will not approve the surgery because the hospital is not a "Center of Excellence". My insurance is Blue Cross Blue Shield (Anthem).......Extremely frustrated. Anyone else had this problem?????

My insurance is BCBS - Anthem....Make sure you don't have the same insurance. They will only ape ospitals in my state - MD

Mine has me penciled in pending insurance approval. Dec. 18. He only does surgeries there on Fridays & the next two Friday's of the year are holidays. So, they wanted to get me on the schedule.
Also, my insurance, BCBS, also suggested that we send all records after my 2nd nutrition visit, next Friday, since they can take up to 30 days to approve. My last nut visit is December 11 & I am needing surgery the following week! That way they can review everything pending that last appt & will know sooner if it's a go or a no go.

@ what hospital did you use I'm using ummc right now but my insurance is switching to bcbs anthem on the first of the year and its not a blue chip hospital but it is a coe will I be ok

Also I'm in MD hope that makes sense

@ what hospital did you use I'm using ummc right now but my insurance is switching to bcbs anthem on the first of the year and its not a blue chip hospital but it is a coe will I be ok

Also I'm in MD hope that makes sense

There are only 2 hospitals in MD that BCBS will approve - St Agnes and GBMC. I tried to get an exception from BCBSvbut they would not do it. I got all my records transferred and they scheduled me right away. My surgery is Monday....I am very impressed with their whole program and Dr. Devoc is awesome. She is due to have a baby Christmas Day and will be taking off 2 months. They have 2 other surgeons though

Damn I was hoping that wasn't the case because I really love my nutritionist she's just awesome but looks like I'm changing at the first of the year I'll call gbmc on Monday and get the ball rolling so I don't miss a month I really really hope the program at gbmc is just as awesome as the one at ummc

Wow---your story resonated with my own initial experience! My primary care provider referred me to "a facility which shall not be named"--and I started navigating the required hoops way back in January of 2015...I paid my required co-pay each visit...and then, oddly enough (RED FLAG ALERT), unpaid bills started arriving in the mail.

I called the surgeon's office, and they assured me that "nothing was wrong"...I called my insurance, and ...let's just say, PLENTY was wrong. The insurance was not paying because this surgeon had let his credentialing w/ United Healthcare lapse...he was listed on a old/ outdated list of providers...but was technically "out of network"...AND...they had let their Center Of Excellence certification lapse...Which is a BIG deal.

"Center of Excellence" isn't just some title slapped on a certificate to make the place look wonderful...it is a status/ standing that is awarded-- by insurance carriers--- to facilities who have an exceptionally low post-op complication rate. This particular facility LOST their Center of Excellence rating---> due to post-op infections, post-op ordeals of too many kinds to list...and United Healthcare refused to grant it back, until a pre-determined time of extremely LOW complications and stringent criteria had been met....and this place just couldn't swing making that happen.

Long story short, my insurance quickly redirected me to a top-notch surgeon and a hospital that exceeded 'Center of Excellence" criteria & I had my procedure done Thursday, 11/19/2015.

Trust me...don't be upset over this...be GRATEFUL...Grateful that you won't become a post-op statistic for some provider that doesn't care enough to maintain credentialing and go above and beyond for their patients.

This is an elective procedure...not emergency surgery made while you're fighting for your life on a gurney in an ER...Take the time to research your surgeon, the facility...all of it. We are in control of this...WE decide who to entrust our bodies to for this life-changing surgery---Don't settle...your insurance is protecting you!

It sounds like your particular surgeon likey "once had this certification"...otherwise, you'd have never been referred to them in the first place...and if they lost certification (and it sounds like they DID)...they definitely aren't going to go announcing it from the rooftops, because that means lost revenue---fewer patients. The sham of a surgical center I initally dealt with actually thought I would pay out of pocket to remain under their care...and had hoped I'd just circumvent my insurance, and pay them cash for my surgery, disregarding their lack of stellar certifications.

Hmmm...How about NOT. I ran like the wind after finding that they knew ALL ALONG that they failed to meet the criteria...so every appointment was filled with lies...Why trust a place like that with your body? With your health and well-being?

Damn I was hoping that wasn't the case because I really love my nutritionist she's just awesome but looks like I'm changing at the first of the year I'll call gbmc on Monday and get the ball rolling so I don't miss a month I really really hope the program at gbmc is just as awesome as the one at ummc

Hopefully, you think so too