. Do I need a lawyer ALREADY?

My surgeon's office has not even filed with my insurance yet.  My problem is that I am already getting conflicting information from my insurance company and my employer.  Since 3-2-2007 I have been told by my insurance company AND my employer that bariatric surgery is NOT excluded.  We even discussed where I would need to go & the percent @ which it would be covered.  (I work for a hospital and they write their own plan...)  Our hospital is a bariatric center of excellence.  I was not planning on going there, but I WILL go there if I have to.  My employer rep said I can go to the hospital I work at OR the hospital near me.  Today I called my insurance to see if anything had been filed yet and was told that it had not.  Upon further discussion the lady says it (bariatric surg) is not a covered benefit.  This is the FIRST time I have heard this EVER.  So she said she would check with her supervisor and call me back.  I got a message saying it (bariatric surg) was not a covered benefit.  So I called the insurance company back because I think they are wrong.  Other nurses in my hospital have had it done.  The lady that writes the plan for my hospital told me on 3-29 that it was covered; it is covered @ the hospital I want and it is covered @ 80%.   My problem is that I can get NO ONE to send me a copy of my certificate of coverage.  I have never received it.  Humana says they don't have it since it is an employer written policy  (How then would they know what is covered?)  My employer always has some excuse; they computers are down, etc... The lady I talked to tonight is going to have the Humana supervisor call me in the am.  I have a call out to my employer rep, but have had no call back from her yet.  I feel like these people don't even know what is covered, so how on earth  am *I* supposed to find out?  What can I do when they can not even give me the certificate in writing? (And why would a bariatric center of excellence NOT cover it for their own employees?) Seriously, what am I supposed to do? I am starting to call the surgeon's office daily so it can at least get initially filed so that if I am denied I can appeal, but without the certificate, how do I even know what to appeal? Melanie g.

You are legally entitled to a copy of the policy.  Don't listen to anything they TELL you.  you'll get 10 different answers  The Center of Excellence thing has nothing to do with private insurance.  The ASBS and SRC created this "concept" for some reason, they say to keep standards high.  But only medicare uses the COE concept.  Private plans don't care.  They deny.  So, they create this standard that only medicare follows, and in fact, if you need a revision medicare doesn't make you go to a COE.  Also, if the hospital is a COE the surgeon doesn't have to be as long as he has the required number of surgeries per year.   Could you imagine less then 400 COEs in the entire US?  Only 3 in Alabama.  The entire state.  9 in Tennessee.  Don't get me wrong.  There needs to be standards and safety protocols.  But why does it come with a fee$$$ to join a group and get approved by this group who set their own standards.  Imagine any other area where you had to go to a COE.  Not your trusted cardiologist.  But a doctor some company created to "track outcomes" and make money picked for you????? People want to get active?  Then write their politicians and tell them this COE thing is useless.  Doctors are now stopping accepting medicare because medicare pays very slooooowly.  So now you have doctors dropping out of medicare and docs excluded because they're not COE's. ok, enough about COE's. Get the policy.  Keep bothering them.  Then, if you get denied, read the letter.  It should tell you what your appeal rights are.  Be persistent.