This isn’t really a rant or a rave. More just a topic that I am curious to hear others thoughts on. I had my psyc eval this morning and it got me to thinking….a lot. On one hand I was extremely irritated that I feel like we are being discriminated agains to have to do a psyc eval to begin with while on the other hand I question whether a one time appointment is enough and we should be required to do more.

First let me say that when I say that it should be required for us to do anything I do not believe that insurance companies should be the ones dictating ANY of this. I think that doctors should be making medial decisions, period. With that being said they are involved so should they be allowed to require a psyc eval for one surgery and not another? Not ANY others as far as I know. I mean all the hoops that are required for weight loss surgery, I haven’t done anything like this for any other surgery It really feels like discrimination. How is it that in this day and age they are still getting away with it.?

On the other hand are they on to something and is the evaluation really enough? For those of us who have been through it all would you have benefitted from ongoing therapy to deal with all the life changes and some professional help to change the disordered eating behaviors that most of us have to some degree? Should this be a requirement? Or perhaps they should just have to educate us about therapy and provide access to it for those who choose it. Or instead of the evaluation beforehand require one visit post surgery just so we could see what therapy is like and we can decide if it worth it. Maybe the surgeons should be required to have a therapist on staff that can handled their patient load. Should the doctors step up and require more of their patients than the insurance company does (if they believe it’s beneficial)? Is that even allowed? or should all of this be the patients decision?

Just something to think about

Edited July 9, 20242 yr by ShoppGirl

Hard to be wrong when you take both sides.

I expect that with time the Psych eval will go completely away. Back in the day it was considered necessary and some people were even turned down or delayed in favor of therapy. Being bumped was a legitimate concern in my program, but I fooled them completely. Now it's a rare case that the psych eval changes anything. Some programs have patients take a psych test online, no shrink. It's a box to check on a list. Insurance will eventually want to save that money. Or maybe not, it may save them more as a stumbling block on the way to surgery. See, I can take both sides too.

As for actual therapy before or after surger, I'm torn. Requiring therapy is a bad idea. If the patient isn't completely engaged and prepared to be honest in therapy it's a waste of time. The therapist only knows what they are told. Carp in carp out. You can't require engagement or honesty.

I agree that therapy for most of us would be benificial with the above caveats. Well, not for me, of course.

Good luck,

Tek

27 minutes ago, The Greater Fool said:

Hard to be wrong when you take both sides.

I expect that with time the Psych eval will go completely away. Back in the day it was considered necessary and some people were even turned down or delayed in favor of therapy. Being bumped was a legitimate concern in my program, but I fooled them completely. Now it's a rare case that the psych eval changes anything. Some programs have patients take a psych test online, no shrink. It's a box to check on a list. Insurance will eventually want to save that money. Or maybe not, it may save them more as a stumbling block on the way to surgery. See, I can take both sides too.

As for actual therapy before or after surger, I'm torn. Requiring therapy is a bad idea. If the patient isn't completely engaged and prepared to be honest in therapy it's a waste of time. The therapist only knows what they are told. Carp in carp out. You can't require engagement or honesty.

I agree that therapy for most of us would be benificial with the above caveats. Well, not for me, of course.

Good luck,

Tek

lol. This made me chuckle a few times, thanks for that. Yea I know I cant seem to take a side. I finally landed on the fact that they just need to take a long hard look at the system as it stands and give it an overhaul. Seems like maybe it’s been quite a while since they have. I think I may be onto something in them requiring one actual therapy visit post op instead of this evaluation pre op (that’s I agree seems more of a box to check than anything else). Just so the patient can see what it’s all about and decide for themselves if it’s right for them?? I am talking about what’s actually in favor of the patient succeeding. Not in terms of the insurance company saving money.

Edited July 9, 20242 yr by ShoppGirl

I don't think a therepy session is the solution for which you are looking.

I'm shocked and dismayed by the questions posted here by early post-ops. Everything should have been covered by their program team. Nay, it should have been pounded into their patients heads. What to expect, possible problems, the diet, and every other last detail. Twice.

Unfortunately, many programs fall terribly short on information.

Another unfortunately, some patients simply don't listen.

The combination can be heartbreaking.

Let's you and I rule the world and make some changes!

Tek

Edited July 9, 20242 yr by The Greater Fool

My friend failed the psych evaluation twice. She had unrealistic expectations of the surgery and for herself. She wanted an easy way and the psychologist feared she was going to hurt herself. So... she went to another and then another. The third one approved her and she had her surgery in 2015. On the other hand, my virtual psych evaluation was 20 minutes, cost $40, and I don't think the woman even looked at me.

I absolutely agree that it is not warranted or necessary for the surgery. Doctors need to make that decision regarding their patient's care. As far as my surgeon was concerned, it was another box to check off and nothing to worry about. She didn't take it seriously, but did require it only to meet the insurance company's requirements.

Edited July 12, 20242 yr by DianeF
to remove familial link

1 hour ago, DianeF said:

My friend failed the psych evaluation twice. She had unrealistic expectations of the surgery and for herself. She wanted an easy way and the psychologist feared she was going to hurt herself. So... she went to another and then another. The third one approved her and she had her surgery in 2015. On the other hand, my virtual psych evaluation was 20 minutes, cost $40, and I don't think the woman even looked at me.

I absolutely agree that it is not warranted or necessary for the surgery. Doctors need to make that decision regarding their patient's care. As far as my surgeon was concerned, it was another box to check off and nothing to worry about. She didn't take it seriously, but did require it only to meet the insurance company's requirements.

Yea. Mine seemed like a joke as well. I mean he did ask questions about my history and my expectations as well as what support system I had and stuff like that. I just didn’t feel like it was really on depth enough. I feel like someone who was just saying all the right things could have easily passed.

On 7/9/2024 at 7:37 AM, ShoppGirl said:

This isn’t really a rant or a rave. More just a topic that I am curious to hear others thoughts on. I had my psyc eval this morning and it got me to thinking….a lot. On one hand I was extremely irritated that I feel like we are being discriminated agains to have to do a psyc eval to begin with while on the other hand I question whether a one time appointment is enough and we should be required to do more.

First let me say that when I say that it should be required for us to do anything I do not believe that insurance companies should be the ones dictating ANY of this. I think that doctors should be making medial decisions, period. With that being said they are involved so should they be allowed to require a psyc eval for one surgery and not another? Not ANY others as far as I know. I mean all the hoops that are required for weight loss surgery, I haven’t done anything like this for any other surgery It really feels like discrimination. How is it that in this day and age they are still getting away with it.?

On the other hand are they on to something and is the evaluation really enough? For those of us who have been through it all would you have benefitted from ongoing therapy to deal with all the life changes and some professional help to change the disordered eating behaviors that most of us have to some degree? Should this be a requirement? Or perhaps they should just have to educate us about therapy and provide access to it for those who choose it. Or instead of the evaluation beforehand require one visit post surgery just so we could see what therapy is like and we can decide if it worth it. Maybe the surgeons should be required to have a therapist on staff that can handled their patient load. Should the doctors step up and require more of their patients than the insurance company does (if they believe it’s beneficial)? Is that even allowed? or should all of this be the patients decision?

Just something to think about

I see your point, but I think the psych eval is necessary. Weight loss surgery outcomes are much better when used along side pysch evals, dietician visits etc. This is all documented and confirmed by the medical community. I think if I was an insurance company, I would prefer to pay out for a surgery that it likely to be successful because the patient is using all the tools in their tool belt and is more likely to be successful. I would also think that more than one appointment with a psychologist should be the norm. You can sometimes do more harm than good with only one therapy session.

I don't see it as discrimination because ultimately, it's an elective surgery. We can live (albeit less well) if we are overweight. There are also other surgeries that require psychiatric evaluation too, for example gender surgeries. It's not really discriminatory to require that the person getting certain surgery is likely to have a successful outcome because the require life changes to be successful.

However, I definitely agree that it shouldn't be down to the insurance companies to determine the requirements, it should be medial professionals. Insurers should never get the final say in what procedures a patient can or can't get if the doctor disagrees with the insurance company. I also don't think a tick box appointment should be enough to get approved for a major surgery which is what insurance requires.

For surgery on the NHS, it has to be shown that the patient is fully aware that the surgery is only a tool and that the patient has realistic expectations of life post-surgery. We have to show and understand that we are prepared to put in all the necessary work (daily vitamins and regular blood tests, to adhere to the rules of eating both immediately after surgery while we heal and then the lifelong commitment required to maintain their losses)

I’m glad that my NHS Trust has hoops to jump through if I’m honest, as it inspires confidence for me. Would I love surgery now? Of course! I’m I mentally prepared for it? No, I don’t think I am. The past couple of weeks have shown me that I do respond to emotional situations by trying to soothe myself with food. Will I be able to do that post-op? Very, very doubtful as I would be worried about undoing both the surgery and the psychological readiness I know I need to undergo said surgery.

I do read some posts on various forums that do give cause for concern as a pre-op patient, just as Tek identified above. I’m in no position to advise but it is comforting that the more experienced posters do their utmost to give advice and guide the user in contacting their surgeon, doctor etc or to re-read the advice they should have been given ?

7 minutes ago, MrsFitz said:

For surgery on the NHS, it has to be shown that the patient is fully aware that the surgery is only a tool and that the patient has realistic expectations of life post-surgery. We have to show and understand that we are prepared to put in all the necessary work (daily Vitamins and regular blood tests, to adhere to the rules of eating both immediately after surgery while we heal and then the lifelong commitment required to maintain their losses)

I’m glad that my NHS Trust has hoops to jump through if I’m honest, as it inspires confidence for me. Would I love surgery now? Of course! I’m I mentally prepared for it? No, I don’t think I am. The past couple of weeks have shown me that I do respond to emotional situations by trying to soothe myself with food. Will I be able to do that post-op? Very, very doubtful as I would be worried about undoing both the surgery and the psychological readiness I know I need to undergo said surgery.

I do read some posts on various forums that do give cause for concern as a pre-op patient, just as Tek identified above. I’m in no position to advise but it is comforting that the more experienced posters do their utmost to give advice and guide the user in contacting their surgeon, doctor etc or to re-read the advice they should have been given ?

I'm an NHS patient as well. I can fully understand needing hoops to jump through before spending public money. I think the thing for is I had to stop and think at each stage if it all was really worth it so each barrier gave me time to re-evaluate. My first group session, you could tell there were a lot of people who weren't suitable yet, because they wanted the "magic wand solution" and were disappointed this isn't it. And then about a third just wanted ozempic because they thought it meant they didn't need to do any work. Every stage made me sure I am ready to put the work in now.

37 minutes ago, NeonRaven8919 said:

I'm an NHS patient as well. I can fully understand needing hoops to jump through before spending public money. I think the thing for is I had to stop and think at each stage if it all was really worth it so each barrier gave me time to re-evaluate. My first group session, you could tell there were a lot of people who weren't suitable yet, because they wanted the "magic wand solution" and were disappointed this isn't it. And then about a third just wanted Ozempic because they thought it meant they didn't need to do any work. Every stage made me sure I am ready to put the work in now.

I also think that all the stages reiterate how serious this kind of surgery is too. It certainly isn’t for the faint hearted or those wanting the loss thinking this is the easy way.

My first group session sounds very similar to yours. The nurses said right at the very beginning that jabs like Ozempic or Wegovy were not available and you could see that some were disappointed. My next group session is in August so it will be interesting to hear from others at that session. We were given a lot of reading matter to familiarise ourselves with the whole process and encouraged to contact the Bariatric department if we had any questions or concerns, which I found reassuring.

2 hours ago, MrsFitz said:

I also think that all the stages reiterate how serious this kind of surgery is too. It certainly isn’t for the faint hearted or those wanting the loss thinking this is the easy way.

My first group session sounds very similar to yours. The nurses said right at the very beginning that jabs like Ozempic or Wegovy were not available and you could see that some were disappointed. My next group session is in August so it will be interesting to hear from others at that session. We were given a lot of reading matter to familiarise ourselves with the whole process and encouraged to contact the Bariatric department if we had any questions or concerns, which I found reassuring.

My next group session is in August too! Just curious if your hospital is UCLH?

56 minutes ago, NeonRaven8919 said:

My next group session is in August too! Just curious if your hospital is UCLH?

No, I’m a Yorkshire Lass for my sins!

"I mean all the hoops that are required for weight loss surgery, I haven’t done anything like this for any other surgery It really feels like discrimination. How is it that in this day and age they are still getting away with it.?"

I wholeheartedly agree. I think about this when I think about skin surgery not being covered by insurance because its "elective" "plastic surgery" yet transitional surgeries are covered and "elective".

Both are to help with how we see ourselves, what our inner selves are, our mental health! The differences are one can cause bad rashes, difficulties wearing clothing and getting around/exercising, back pain/skeletal pain from excessive hanging skin weight and is caused by treating a disease. The other involves self perception as well and can cause mental distress, yet is readily covered by insurance and yet involves "healthy body parts."

To me it IS discrimination, why cover one without question but not the other? Heck, transitional doesn't even require therapy now. Both are major changes in a life.

I always got the impression insurance companies refuse to cover skin surgery because we "brought it on ourselves" opposed to it being an actual symptom from a disease. I have rosacea which is purely a visual thing yet its covered, as is acne, warts etc...all covered. Yes, they're cheaper to cover, but are a disease that's visual that's covered they also won't cause a secondary problems. They will even cover breast reductions for back pain, why not excessive skin for back pain?

I personally found no worth to the therapy session, I knew and know what caused my obesity and what I needed to do to get healthier. Some may not. It should be voluntary or required if people start to back slide gaining weight after surgery but to me beforehand was pointless. It would have been more helpful to cover the changes in your life that would be happening. Yes, I was also required to do a group session with ppl who had gone through it or were..but it was a structured topic put on by the dieticians. Perhaps if they offered mentors or group sessions for dealing with life changes..that would be better..ppl who've gone through it, not someone schooled on what its supposed to be like..that would be better opposed to a size two I've never battled with my weight therapist/dietician!

Edited August 31, 20241 yr by BlondePatriotInCDA