on 1/13/14 9:17 am
I am new to this website. I am talking to a Dr. about the Surgery and I am going thru the several tests for my eligibility. I have a question that I hope someone can answer before I go back to my Dr. What is the necessity for having a Mental Evaluation? The reason I am asking, I received a call from a Physiologists office regarding scheduling an appointment. I was told that since "Obama care" kicked in that the Mental testing is NOT covered under my Health Insurance anymore, and the I need to see the Dr. for multiple sessions and for testing that runs about $125 an hour. Again, is this a necessary requirement for the Surgery, or should I go back to the Dr. and say that since Obama care is changing Insurance that they need to rethink this testing as I cannot afford $1,000 out of pocket for this testing??
on 1/13/14 9:39 am
I only needed to go twice. Secondly, the Bariatric unit can give you a list of professionals you can see. Then call and find out prices. You may be able to find one for less. Ask about the number of sessions you need, too. Hope this info helps.
on 1/13/14 9:58 am
Unfortunately, I did call one of the Professionals on the list the Dr's office gave me. I am also wondering if anyone else is having the same issue with Insurance not covering Mental Health for 2014 year. I have Blue Cross and Blue Shield (PPO) and have been on the same plan for years. I just wonder since Obama-care has kicked in if the Insurance Companies are now just going to cover less!
You need to call your insurance company and find out what your specific policy covers. Also, you need to find out if your insurance company requires a psych eval for WLS. (It may be your surgeon's requirement, not your insurance company's.) My psych eval was a surgeon's requirement, and I did have to pay out of pocket---but it was only one visit, and I think it cost me about $125. It was about 45 minutes of talking one-on-one with the psych, and we discussed things like my diet history, why I was MO, what my expectations were, and whether I understood my particular surgical choice and how it would force me to change my life. No biggie.
A psych eval IS important, because this is a huge life change. Many, many people become depressed following WLS, for a variety of reasons. Rapid weight loss dumps a lot of stored hormones into our bloodstream, which can lead to a real emotional rollercoaster ride. It's important you understand what to expect, and when you need to ask for help. (There are some great mood-altering medications available now.) It's also important to make sure you're emotionally stable and sufficiently well-informed to make a sound decision. It's not designed to keep you from having WLS, unless you really need to NOT have WLS.
on 1/13/14 6:17 pm
The psychological evaluation is primarily to evaluate your ability to handle weight loss surgery and the requirements of diet and exercise ha*****ange that will come after. It is major permanent surgery, and the evaluation will help determine your readiness for those changes. It also evaluates for preexisting conditions such as depression, anxiety, or other forms of mental illness that might impact your ability to respond well to the surgery and those changes which are essential for short term as well as long term success. In addition pre-existing mental health issues can effect the risk of complications.
Surgeons have gotten stricter about the mental health requirements for surgical workup than they used to be because so many people have had difficulty managing the requirements post-op.
So, yes, you will most likely have to do the mental health evaluation your surgeon requires- it is an essential part of the pre-surgical workup.
"What the caterpillar calls the end of the world, the master calls the butterfly." Richard Bach
"Support fosters your growth. If you are getting enough of the right support, you will experience a major transformation in yourself. You will discover a sense of empowerment and peace you have never before experienced. You will come to believe you can overcome your challenges and find some joy in this world." Katie Jay
Who told you that it wasn't covered because of the Affordable Care Act?
Many insurance companies have new mandates for things they MUST cover - meaning more is generally covered now. And there are multiple policy variations within each company. I've yet to hear of an insurance company covering less. In my own case, I see a psychologist and a psychiatrist (not for WLS) and they are both still covered.
Pre-op, I saw the psych twice: once for a quick visit and a long test on the computer, the second time to get the results.
I'd call your insurance company and not the psych folks. Insurance is the one that will make the decision, and they can tell you how to appeal if they actually do decline your visit.
If you really can't afford it, talk to your doc. Who knows? He may waive the requirement. Personally I don't think that would be a good idea; this surgery is a big, life-altering deal and they do the psych tests in order to know how to help you succeed postop.
At any rate, best of luck to you in your journey,
Watch your thoughts, for they become words. Watch your words, for they become actions.
Watch your actions, for they become habits. Watch your habits, for they become character.
Watch your character, for it becomes your destiny. ~ unattributed
I definitely second Amy's suggestion about calling the insurance company. Part of the Obamacare requirements are that EVERY insurance policy provide general mental health coverage, but that may or may not include a pre-op Psych eval.
Most people only have to have one evaluation (that is usually just one session, but might be broken into two sessions if they give you questionnaires to fill out) and it isn't generally categorized as Testing (even if they give you a depression questionnaire or something similar), so if you ask the insurance company about whether there is coverage for a "pre-operative Psychological clearance" you will get a more correct reply than if you refer to it as "psychological testing" which is a different animal. (I have a Psych PhD and do pre-op psych evals part time.)
Does your surgeon ONLY use a particular Psychologist? Is the requirement for multiple sessions your surgeons's requirement or your insurance company's requirement? I would also second the suggestion, if you find out that your insurance does not cover any of it and it is your surgeons's requirement, would be to talk to your surgeon's office to see if they have any suggestions.
6 years out and maintaining 190 pounds lost!
“You don't drown by falling in the water. You drown by staying there.”