| Tue, Jun 02, 2015 @ 09:00 AM

Scheduled for Surgery? Ask About Centers of Excellence.

Posted by Medicare Made Clear

surgeryWhen you’re in need of a medical procedure or surgery but it’s not an emergency, you have time to ask questions and search out the right doctor and the right facility for you.

Some health insurance companies may offer help with your selection. They may be able to identify hospitals or clinics with top success rates for the procedure you need. Some insurance companies call these Centers of Excellence.

Susan Morisato, President of Insurance Solutions, UnitedHealthcare urges patients to ask about Centers for Excellence when facing surgeries that are especially complicated or expensive, like organ transplants, cancer and bariatric surgery. “There are some facilities that have greater expertise, greater volume, and that may result in fewer complications and better outcomes. Centers of Excellence are certain facilities or providers that potentially specialize in certain kinds of procedures. So if you are going to have a procedure they specialize in, it may be to your advantage to be in a Center of Excellence. For example, if you need a cardiac procedure or cancer treatment you may want a certain amount of expertise, knowledge and experience. It may be helpful to go to facilities that specialize in those kinds of procedures.”

A Center of Excellence is usually judged on:

  • Rate of complications
  • Survival rates
  • Patient satisfaction
  • Family services

If you don’t live near a Centers of Excellence, Morisato suggests asking your insurance company about transportation to one. “Certainly it’s worth asking that question because often the plans would benefit by having Center of Excellence providers providing these specialized services. To the extent that they live in an area where it’s maybe not close, I think it’s always worth asking the plan or the insurer whether or not transportation services or other supportive services are available.”

So don’t assume that all Centers of Excellence are part of your insurers’ network. You can always call your insurer to learn more.

For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.


Medicare.gov: Visit the official U.S. government site for Medicare.


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