Experience with Magellan Behavioral Health Therapist Insurance Preauthorization?

81kellograms
on 1/23/17 9:27 am
VSG on 12/01/16

Hello All! First off, I'm brand new. Started at BP then all the recent hubbub led me to here. I'm enjoying the format and members very much!

I'm in my 7th week after VSG and things are moving along as expected with the usual ups and downs that I read about here and elsewhere.

So I have insurance through BCBS (market HMO) and in order to see a behavioral health practitioner, I have to receive preauthorization from Magellan Behavioral Health Inc. I've never seen a therapist before (sans pre-surgery) and would like to start regular therapy sessions to get my brain wrapped around my new life-style and my relationship with food. I know my insurance doesn't cover anything regarding weight loss, I had to self-pay for surgery. So I'm wondering about what questions will be asked of me when I call for this preauthorization. Is there anything I should not say? Should I not say anything about weight loss? I have no idea what questions will be asked of me so I'm just trying to figure this out before-hand. So basically, I want to work the system to my advantage! TIA -kelly

(deactivated member)
on 1/23/17 11:06 am - CA

Welcome to OH!    I am sure you will find some great information on the site along with some awesome people.   

To answer your question, you probably will not be able to get a precert by doing this yourself.  Your PCP or another healthcare professional who treats you will need to do it.   Precerts or prior authorizations are obtained by healthcare personnel for services that are required to be reviewed for medical necessity.   In doing this, the Dr would have to submit the diagnosis, office notes supporting his/her reason for your need for counseling and back up documentation, if any.   Since weight loss is not covered by your policy, I don't see that you will be able to get this approved, unless your Dr. has a alternative diagnosis code that he can attach to your need for counseling that does not involve your weight loss surgery.   I would talk to your PCP to see if there is anyway they can help in substantiating your authorization to see the behavior health professional, but do convey to them that weight loss is not covered.   IF he/she has any diagnosis that will suffice and they have sufficient documentation to support it, you might have a chance.  

Otherwise, you would have to pay for the services out of pocket.   But, also keep in mind some Behavior Health Pros do not accept insurance, they will give you a receipt for services and a diagnosis so you can submit for reimbursement, but most often, these come out of our pocket first.    The only thing usually covered without a need to pay out of pocket upfront, is in patient mental health care or outpatient after a inpatient stay.   

I do hope you can get the assistance from your PCP.   Good luck!

Nik

81kellograms
on 1/23/17 1:23 pm
VSG on 12/01/16

Actually, no it specifically says that I don't need PCP referral. Calling this third party Magellan company is all that's necessary. I've already checked and the therapist I would like to see is in my network and submits insurance. If I have to end up paying out of pocket, that's fine, I would just like for this super expensive insurance to actually cover something! Thanks!

Mary Gee
on 1/23/17 11:36 am - AZ
VSG on 05/14/14

I bet you're suffering from anxiety, worrying about being able to stay on track and adjusting to your new life-style.  Your doctor could probably give you a referral based on anxiety.  I wouldn't think he/she would have to specify the cause of anxiety.

Good luck to you.

       

 HW: 380 SW: 324 GW: 175  

 

 

 

 

 

 

 

81kellograms
on 1/23/17 1:28 pm
VSG on 12/01/16

I bet I am too! I mean really, isn't anxiety caused by life in general? I would think that a therapist is going to talk to me about everything under the sun if that's what I need. Work, relationships, finances, career . . .

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