Psych Evaluation

[lucybugsmama 0]

I got approved for the band and the doc said the next step is a psych evaluation. They have a pysch that works in their office, but she does not accept insurance. They said I can used my own pysch if I'd rather have insurance pay, but I'm lost. I know how to find a psych on my insurance, I just don't know what to tell them I need to meet the requirements of the surgery. What kind of evaluation do I need? Has anyone found a pych on their own, and if you did how?

I'm in DFW (Arlington) so if anyone has recommendations in this area, please share. But really, just any advice on how to find the psych would be much appreciated.

[Nean4488 1]

I suggest you go threw someone that accepts insurance, its nuts if you pay for no reason!

[trishfish 1]

the psych my doctor uses didn't accept insurance either I payed cash up front then submitted it to my insurance and got reimbursed....i would see if the psych is covered under your insurance and the submit it...i wanted to stay within my doctors practice...good luck!!

[mscafe32 0]

If you don't want to pay for the eval by yourself, you can go 1 of 2 routes.

1.) Call your insurance company to see if your plan has out of network benefits. If it does, while you have them on the phone ask them what the allowed amount is for an initial mental heath consultation and if pre-authorization is required for outpatient mental health services. If pre-auth is required, then they will tell you what you need to do to before your appointement. If not then you just go to your appointment with the psych at your doctor's office and make sure she gives you a detailed receipt and submit a claim to your insurance company. You will then get some reimbursement based on what your plan says. But keep in mind that it may not be that much. For example, my out of network benefits are covered at 50% of the allowed amount. My daughter had an appointment with a highly recommended Neurologist that did not participate with my insurance. I was charged $350 for the appointment, but under my health plan the allowed amount is only $175. So my insurance only paid $67.50. (which is half of the $175 minus my $20 co-pay) So I paid $282.50 out of my own pocket. But hey, your insurance may be better than mine any pay a higher percentage.

OR

2.) Get a list of participating providers from your insurance company. You can usually do this online or you can call member services and they can give you a few over the phone within a certain proximity to your home. Take some time to sit down and call the providers and tell them that you are a pre-op bariatric surgery patient who needs a psych eval to be cleared for surgery. It is important that you make sure the provider actually provides this service on a regular basis because they will need to have the correct assessments and health insurance company criteria. If they begin asking you questions about what needs to be done or what exactly you need from them, then move on to the next person on the list because that means they are not familiar with the process and you will end up paying for an eval that is unacceptable to your insurance company.

[lucybugsmama 0]

Wow, Mscafe32, thank you! My insurance does have out-of-network services, I hadn't even though about that. I ad gone online and printed the listed of providers, I just had no clue what to say when I called to see if they could do this. You are a wealth of knowledge!

[mscafe32 0]

No problem. I have a daughter and a stepson with special needs so I am used to dealing with insurance companies and medical providers and on top of that I work at a hospital. Let us know when you find someone.