Is a psych eval medically ness?...

How do I know if the psych eval is medically ness? My insurance does not require a psych eval for approval, I am already approved for surgery with a date of aug 6th. However my surgeons office does require a psych eval for every patient before surgery. Okay so that is fine, I call my ins and ask if I have out of network benefits for the psych doc that the surgeon recommended. The rep that I was talking to said they would cover it, only of it was medically ness.  I asked him so how do I know if it is? He says I dont know, they will just have to submit the claim.  I am thinking if I have to do this for surgery and I have been approved doesnt that mean it is medically ness? If they dont cover it, the fee is 350.00. Is that a little high? I am just a little confused here, any thoughts on this...

My surgeon also requires a psch. eval, which is 300.00 and it says in my handbook-not covered by my insurance.  So I guess comapred to the cost of the surgery which they are covereing, I'll eat the cost.  Good luck to you! Kim

My personal opinion...It's not necessary, but many insurance companies and doctors require it and so it's another hurdle that we have to jump through before we are approved.  I think the doctors want to make sure that the support is there for someone after surgery and that the person having the surgery fully comprehends what is going to occur and the changes they will face.  I think if a person wants the surgery bad enough, they will say whatever is necessary to manipulate the system and have the surgery. I know one person who had it a few years ago and she was not ready.  Now she eats whatever she wants to, is not concerned about dumping, and does not get her protien or take the vitamins anymore.  She also has developed an eating disorder because she will make herself regurgitate things she knows that she is not supposed to eat.  Just my two cents. 

I think the psych eval is basically to determine whether or not you are mentally stable and are able to make your own decisions. Some people are mentally challenged and incapable of comprehending what all the surgery consists of. If someone is 38 years old and has a mental capacity of a child they truly will not understand what they may be doing to their bodies. There could be someone else in their life telling them this is what they should be doing. This is (to me) what they look for in your eval. However the patient's pcp should be able to determine if the patient is coherent enough to make the decision on their own but if not then send them for the evaluation. If the costs were lower or if the insurances would cover it then it wouldn't be that big of a deal, but when you dish out $295 out of your own pocket it's a little rediculous. My checkbook feels your pain.

My advice to you is to have it done whether or not the insurance will pay. Look at the big picture. You are trying to gain approval to pay for a +- $40,000 surgery that will change your life. $350 is high but if you can pay it at all then do it. Some insurance companies don't pay at all under any cir****tances but you could get lucky with yours since they said "if it was medically necessary" they would cover. Good luck to you.

MELISSA

Hi Amber! I had to have a psych evaluation for my insurance to cover my surgery.  I had to pay for it --it wasn't covered by insurance company.  I don't know if it is "medically necessary" but I think it's pretty much standard procedure.  Good luck! Freddie

The psych exam is usually required by the surgeon, not the insurance company.  The purpose of this exam is to make sure that you are mentally equiped to handle the changes you are going to be  put through.  It is to make sure you realize that you are not "taking the easy way out" and to make sure you can be successful.  Your surgeon can probably write it as a referral so that the insurance will pay for it.  The price sounds about even across the board from $300-$400.  It is in your best interest and shows you that your surgeon is concerned for you as an individual and not just making more money for another procedures. Just from my experience, I was self pay, I would have been glad to just pay this amount if insurance had covered me.  My total out of pocket was well over $25,000. Good luck with your journey Darlene

 My doctor requires a psych exam.....it is for your benefit...and to have good documentation for the surgeon.................Some surgeons provide  their patients with a list of approved docs. Good luck!!

My insurance requires it so I went to Dr. Victor Obryan at Baptist Hosp.  It cost me $200.  Not sure if insurance will cover, if they don't then the I won't get $$ back, if they do I might get some back.  Otherwise $200 was it.  Try there perhaps, cheaper than $350. 

I had to pay $300.00 for my evaluation and it was an out of pocket expense as well.   I also believe that they not only want to know if you understand the lifelong dedication that this surgery requires, but if you have to put a financial investment into something, you are more dedicated to the success of something.  Kinda like if a child has to pay for a toy, they take better care of it, than something that was just given to them!!! Ask your doctor and see if they other options that you can choose from, but most have there perferred doctors, because they know what they are wanting and looking for. You can do it!! Good Luck,  Shelia

Hi Amber, I saw 3 psych's and denied by all three.  One gave me a 2 hour test.  Denied. Another said I was unstable for the recovery and there after.  I'll give him unstability.  He costed me $229.  He gave me the test to take in the waiting area with everyone around me talking and mom constantly talking to me or someone else.  Hard to conscentrate.  I didn't pay him, I gave him my medicade phone number since I was out of state.  A third one said that I needed an years worth of therapy before he would even consider it.  Dr. Colquitt in Maryville just south of Knoxville requires the eval.  He accepted a letter from my shrink and therapist that I have been under their care for several years and in their opinion I was more then ready for the surgery, and in their opinion it would help with my depression and increase my self esteem by having the surgery.  He accepted that, otherwise the psych he would have sent me too, was the one that said I would need a year's worth of therapy before he would even consider me for a candidate. I can't always get my water in, or my protein, because I do have leukemia and the chemo pills love what little bit of protein I do get in and flushes it thru my kidneys and out.  So it's a daily fight but I do try.  I have to stay on a high carb diet, low sodium just to keep from losing anymore.  I basically just have skin covering my bones.  The only area that still has fat on it is the thighs.   I saw 12 different surgeons and they all require the eval or they won't do the surgery.   I pray you get qualified from the eval to have your surgery. May God travel with you on this new journey,