Psych Evaluation and Insurance

ncguy3000
on 6/17/15 8:44 am, edited 6/17/15 8:46 am

Has anyone had issues with their insurance when it comes to the psych evaluation that is required as part of the process for the surgery? I went to the psych evaluation that was referred by the surgeon and dealing with my insurance Coventry they are saying that he is out of network when it comes to the psych evaluation for the bariatric program but i could go see him for any other psychiatric issues and then he would be considered in network for my insurance. anyone else have this issue and if so how did you get it resolved?

MaronitaMay
on 8/21/15 12:55 am

I've not had that issue but as someone who used to work at a health insurance call center, I've seen things like this work out for people by arguing that you went to a contracted WLS doctor and that you did NOT choose the clinician for the psyche evaluation and therefore THEY should cover it.  I would recommend that if they do not want to cover it to inform them you would like to appeal and ask whether they have an appeal process if so go through that, if NOT or you have exhausted the health insurance companies appeal process then you have a right to appeal to your states Dept. of Insurance.

 

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