My first "hiccup" with the insurance company

[Amyllf2 206]

Thanks to many on the board I knew life with insurance companies is not easy. I have CareFirst BCBS in Maryland but apparently my mental health stuff is farmed out to Magellan. I got a referral for my psych eval from the surgeon last week. Had it all set up only to find out they don't participate with Magellan and the self pay amount was $865. No thanks. So like a good girl I get online and look up the list of providers. I start calling around: "Hi, I need to have a psychological evaluation done to determine my readiness and fitness for weight loss surgery. Can you do that?"

The standard response: "Sure, but what exactly do you need?"

I called CareFirst and of course the customer service rep cannot tell me anything. She just kept reading the policy that I already had printed in front of me. Wow, how helpful. Can't I speak to the person in the department that approves the surgery? That doesn't seem unreasonable. Or can't you put me on hold and call that department and ask? Of course not.

So here I sit baffled that the right hand doesn't talk to the left hand.

I meet with the nutritionist for the first time today and I'm hoping to catch my patient coordinator while I'm there to see if she can help me since she is the one that submits to the insurance companies and knows what works and doesn't work. I've read such a wide range of things on here. Some people take standard tests, some people just have a session. I have no clue!!!!!

[Bufflehead 6,358]

I would think your surgeon's office can definitely help you out. Either refer you to another psych they work with who does accept Magellan, or give you a sample approval letter to take to a psych that you find on your own.

However, you may end up paying a fair amount anyway . . . my insurance farms mental health stuff out to Magellan and I had to pay $300 even with a psych that accepts Magellan, because my plan with Magellan didn't cover the testing portion of the visit, only the counseling and writing up the letter. Your plan with Magellan may be different though. Good luck!

[Two.Penguins 37]

The "letter" from my Psychiatrist was scribbled on prescription. .. This is what it said " To whom it may concern : Two.Penguins is competent to give informed consent for gastric bypass surgery. There is no contraindication for this procedure. " .... That was it. Word for word, well with my real name of course. I also asked for it on a visit for my ADHD medication refill. It wasn't a special visit for the weight loss.

[Amyllf2 206]

Thanks for the info!