Insurance woes and psych eval concerns....

[piercedqt78 658]

I submitted several weeks ago to BCBS for preapproval. Last week I get a call saying that I HAVE to have the psych eval before they will even look at my request for preapproval. So I asked if the eval would be covered and they say we have a seperate mental health provider and give me an 800 number to call for more details. I call and speak to the (very nasty) lady at value options mental health providers and was told the following:

1) the psych eval would be covered at 75% for the doctor that my surgeon recomended, if the eval was deemed nessary by mental health standards (aka they don't give a **** if bcbs wants it done) if not nessary it would be paid at 38% (not sure why such an odd percent guessing half of 75%??)

2) there is no way to predetermine how much will be paid until the notes are looked at by the adjuster. Since I am not having panic attacks or any kind of chemical imbalance or drug problem it would most likely be at the 38%. The visit can be as much as $450

To me it seems unfair that BCBS can require something but not pay for it. I have an appt on the 2nd and I am taking my check book with me as I am going to have to pay something that day, at least 25% and they will bill me for the rest. Anyone else have this knid of glitch thrown in after you submitted your paperwork? I ask if BCBS would approve me pending psych eval and was told no way, that is just not done period... I think that sucks but that is life. Anyway, what should I expect in the eval? Are they going to make me look at ink blots?? Or just ask me a bunch of questions???? I get the feeling that they are mostly making sure that there are no eating disorders or problems adjusting to new situations. Any info would be great~Mandy

[TraumaNurse 1]

Not sure what state or type of BCBS you have, but I also have BCBS(of Mass) and Magellen was the mental health coverage. I had to pay my co-pay of $30 and that was it. My surgeon also made the psych eval "mandatory" not sure if that helped BCBS pay for it.. Depending on the psychiatrist you visit they will ask questions regarding your past mental health history, your current support system. What your expectations are after surgery, and the "why" of seeking surgery.. I also had to do a multiple choice questionaire, I think it had 20 question. It all was geared to see if you were experiencing "depression"... I hope that helps.. Good luck!

~Christina~

[nc_longhorn 0]

Hi,

My doctor required the psych eval, and I've already had it. They told me they needed to weed out people who were not mentally well enough to follow the post-op directions. I sort of failed the exam. The dr said that I needed counseling to learn how to stop being an emotional eater. So, now I have to have this counseling before I can proceed. The fee for this evaluation was $200. $100 for the session, and $100 for the written note to the bariatric surgeon. As you can imagine, my insurance is not going to pay anyone $100 for a note to my doctor. To a certain extent, I believe that some of these hurdles are to gauge whether the patient is "committed" and "invested" in the surgery. Though I feel that much of it is just jumping through hoops, I've resigned myself to the fact that this is the only way that I can get there, so I smile and forge ahead!

Good luck to you!

S

[nc_longhorn 0]

Hi,

My doctor required the psych eval, and I've already had it. They told me they needed to weed out people who were not mentally well enough to follow the post-op directions. I sort of failed the exam. The dr said that I needed counseling to learn how to stop being an emotional eater. So, now I have to have this counseling before I can proceed. The fee for this evaluation was $200. $100 for the session, and $100 for the written note to the bariatric surgeon. As you can imagine, my insurance is not going to pay anyone $100 for a note to my doctor. To a certain extent, I believe that some of these hurdles are to gauge whether the patient is "committed" and "invested" in the surgery. Though I feel that much of it is just jumping through hoops, I've resigned myself to the fact that this is the only way that I can get there, so I smile and forge ahead!

Good luck to you!

S

[DeLarla 22]

The psyche eval isn't a big deal. I don't know anyone that hasn't passed it. They just want to make sure you are mentally prepared to change your entire lifestyle. If they find out you are an alcoholic, for example, that's a problem since intoxicated people don't have good eating judgment or make wise choices (drunk folk often chow down cheeseburgers at 3:00 a.m.) Or if you tell them, "there's no way on earth I can eat slow" or "I'm not quitting my Saturday large cheese pizza" then you aren't psychologically ready to undergo weight loss surgery. You have to be willing to let go of old ways, which is why they do the psyche eval.

[piercedqt78 658]

Thanks TraumaNurse, DeLarla and NClonghorn it is nice to know that it is not a huge deal. I am covered with tattoos and I don't want to have to explain why I did that "to my body" I did pick out an outfit that conceals most of my artwork though. Strange I have never felt the need to hide them but I do now. Not that I am ashamed but I just dont want to have my love for body art go against me. I am as stable as the next I suppose. I dont drink or do any drugs and have no eatig disorders. I think I will be ok after all. Thanks again~Mandy

[bubblesstina 0]

Mandy,

My Dr recommended I go ahead and have the eval just in case my insurance required it, so I did. I was like you , a little freaked out about the whole deal but after I got there I was quite surprised!!! I took a 5 page "test" that asked me several questions in different ways, asked me things like why did I think it was necessary to have the surg done, asked if I had ever had depression issues and what had I done to over come them.

I think basically they just want to make sure you are not an emotional cripple or one of those type of people that just likes to have surg done ( like a lot of people ae with cosmetic/plastic surg)

after the "test" I came back and spoke with a councelor ( 2 weeks later) after they had time to evaluate my responses. I think that is another way of weeding out those who are not earnest in really wanting to go through with this. The councellor asked me how I thought the surg would change my life, and asked me if I knew what would happen if I did not do what the Dr. said I needed to do, That kind of stuff.

Honestly I think the real purpose is to weed people out who do not follow through with things.afterall you could answer the questions any way you want, truthfully or not, and you are the only one who knows if you answered truthfully.

Just a little of my crazy thoughts. haha

Hope this helps ease your mind. I also say don't cover up your tatoos if that is who you are, let it show!! Isn't that what this is really about, letting the 'real' you out of that strangers extra large body??

[piercedqt78 658]

I think my main reson for covering my tattoos is that I don't want to see "body mutilation" on the form. Also I don't want them to think that I am body dysphoric (sp?). I am really comfy in my body, it is like a pair of baggy sweats, big and comfy. It is my health that I am concerned about, that is my reasonm for surgery. I personally could be fat forever and would still love myself because that is just how I am. I say I am a medium person in an extra large body !! Maybe I will be a medium person in a medium body in a few years???? That would be much more comfy on my knee and back dont cha think? ~MAndy

[bubblesstina 0]

Yeah, My knees and hips will be greatful for the repreve!!!

Let me know how the eval goes. I kinda got tickled at the questions they asked, I just wish I could remember them now!!

[babsyintx 0]

Mandy,

I dont mean to throw a negative wrench in the fire, but the first surgeon I picked required an extensive psych testing and consult which was a total of more than 6 hours. I was forced to see a shrink that was out of network that worked with the surgeon. I never met her until after the psych testing, but they did have me interview with a student on rotation at the hospital. The end result was that the therapist (who I had never met) decided I needed 12 + sessions of therapy to help me with what she perceived to be anger management issues. Said people with my profile did not do well with the lapband BLA BLA. It took me three weeks to finally meet her. I felt she owed me an explanation. Apparently the student who interviewed me had some strong opinions on whether or not I would be compliant. The therapist stuck to her opinion, I left her office in search of another band doctor and a therapist in my network. The second therapist who I personally selected met with me for 2 hours and said that I no major issues, I knew what I was doing, I wasnt suicidal and I diid not have an eating disorder. She wrote me a letter saying I would be a good candidate. Dr. # 1 would not consider a second opinion from another psychologist even though he told me he would. I found a new lapband surgeon, gave him the letter and had surgery 3 weeks later.

I can understand why you would cover up the tatoos. When the psychologist review your testing and interview you, they are making decisions about your life for which you have no control. And they are not always right. In my case, they were definitely wrong. I am a success!!!!

Babs in TX

334/180/170

[mom2mygirlz920 0]

Hello, I also have BCBS and am just beginning the process. Send me an email at mom2mygirlz920@yahoo.com and maybe we can fight it out together. See ya!! Robyn

[DeLarla 22]

Babs, you are the first person I ever heard that had such an extensive psyche eval. Just more proof that every single doctor is different.

You should see the extensive testing they do in Mexico prior to surgery (NOT.) They take you to the lab for blood, then straight to the cardiologist for about an hour, then to the nutritionalist/psychologist/assistant for a video and small talk, then straight to surgery the same afternoon. My plane landed at noon and I was in recovery by 4:00 p.m.! Mexico does have it's benefits, that's for sure!

[piercedqt78 658]

The insurance is requiring the eval, but the doc does too. I guess I am going to have to have it done either way. I am going on monday the 2nd of May. The doc's office will have the psych's letter on wed the 4th. From what I understand this is what most of her evals are for, WLS. I am sure I will be fine I have the guidelines for the visit and I am going to do fine. ~Mandy

[babsyintx 0]

Hi Lisa,

The first surgeon I went to worked for a hospital with state funding. Their protocol was very strict. I was told by the nurse practictioner that they turn down 1 in 9 patients or recommend therapy for them. The therapist that turned me down had major issues. She cancelled 4 of our appointments to meet and discuss the results and when I finally met with her, she made it clear that she was not happy with the way I treated her staff by calling for test results all the time. She also told me that she had passed out and had to go to the hospital multiple times for testing. It seemed she had some issues herself. Last week at the Texas Bandsters Bash, I met the wife of the surgeon who initially refused to do surgery because of the therapist recommendation. The surgeons wife told me that the shrink that I saw was unstable and that I shouldnt dwell on it. There have been a few times where I wanted to send her before and after pics just to prove how I have done. Many docs do the MMP panel. They ask questions like, "Do you see aliens?" " Do you love your mother?" Stuff like that. Any nincompoop could see through the questions. Its the interview that killed me! LOL

Babs in TX