Psych Eval Clearance is Making Me Crazy

[melyssafaye 181]

Hi everyone! I just need to vent. I completed me 6 month program Feb 5th and have been getting the last few things together but I'm stuck on the psych eval clearance and so frustrated that it's making me crazy.

First, I was on a waiting list to see the Psychiatrist but finally was able to get an appointment on Feb 4th. The doctor required a letter or phone call from the therapist I have been seeing for the past 8 months in order to finalize the clearance. Other than that, she is more than happy to sign off.

The problem is with the therapist. I began seeing her at the beginning of this process because I thought that it would be helpful to explore any other issues that might be impacting my weight issues. I was trying to be proactive because, for me, this is a change both physically and mentally. My therapist isn't well informed about wls and I think she has some prejudices about it. I asked her for a letter a week prior to my eval and she said we needed a session just for that. I did that the day before eval. The psychiatrist then contacted her and she didn't respond. I went for my weekly session and asked again. She said she was going out of town for a week and asked if it could wait. I said no.

She didn't do it before she left. Now, she's back and claims she is backed up and will get to it in the next few weeks.

This is the only thing I'm waiting for in order to submit paperwork to insurance. In the meantime, the psychiatrist won't give clearance and has stated that she wonders if there is a larger issue I'm trying to conceal or if I'm just not willing to follow through.

I spoke harshly to my therapist, trying to make her understand how important this is to me. She says that I seem aggressive and perhaps we need to work on my hostility before she would feel comfortable.

AAAAACCCCCKKKKKKK!!!! I am a fairly same person with no serious mental health issues but this is making me crazy!!! I need therapy after dealing with these mental health professionals!!!

Thanks for listening ????

[marley3 8]

That is awful. My advice is to find a new therapist. You are being treated poorly. Therapists are regular people who come with their own set of baggage. Find a person who listens to you and is willing to work with you. My current therapist is the 3rd one I

Tried within a four month period. When I met her we instantly connected and I trusted her. I've been with her for years now. When we discussed wls she was understanding and supportive. Don't be afraid to make a change. Good luck!!

[Inner Surfer Girl 12,015]

This is terrible. It sounds like she is disorganized and a procrastinator. If she had you come on for an appointment time just for the letter, she could have written it while you were there. If she has reservations about you having surgery or recommendations for you then she would have told you so and/or put it in the letter.

Take a big breath and talk to her frankly. Try asking her what you can do to help her provide the letter. If you can take it out of the adversarial realm you may get better results.

Best of luck. I know hold-ups and hiccups are frustrating, but they seem to be an almost inevitable part of the process.

[melyssafaye 181]

Thanks!! I plan on changing or at least not seeing her anymore. She says that she is too busy to do this, so I plan to help her not have so many clients to deal with by giving her one less.

That being said, I don't know what to do now. I still need her to speak with the psychiatrist in order to get clearance. It's like a bad break up where you have to be nicer than you want in order to get the paperwork done.

Without her, I won't be cleared.

[Inner Surfer Girl 12,015]

I agree, do what you need to do to get her to complete your clearance.

Looking for another therapist also sounds like a great idea.

This whole process takes patience, positivity, and persistence.

[claddagh66 132]

Can you get your psychiatrists to call her for the clearance? Instead of waiting on her which seems like it's impossible do it backwards and get it done for yourself. Maybe just them talking and getting in contact is all you need. Such a shame your dealing with this. Sorry this has happened for you. Very unfair

[melyssafaye 181]

The psychiatrist has reached out to her via phone, email and faxed over the HIPPA consent form I filled out and signed. At first, my therapist claimed she was too busy with other clients to get to it.

Basically, she's ignoring the contact attempts. I asked her send the letter two weeks prior to my eval, in an attempt to have everything in order to make clearance quick and easy.

During our session to talk about the letter and issues surrounding surgery she said some things that make me think that she has some prejudices about wls and overweight people. I am definitely going to find a new therapist.

I really appreciate the support. I know it will likely work itself out, but this is so frustrating when I'm so close.

[WLSResources/ClothingExch 3,444]

First, I was on a waiting list to see the Psychiatrist but finally was able to get an appointment on Feb 4th. The doctor required a letter or phone call from the therapist I have been seeing for the past 8 months in order to finalize the clearance. Other than that, she is more than happy to sign off.

The problem is with the therapist. I began seeing her at the beginning of this process because I thought that it would be helpful to explore any other issues that might be impacting my weight issues. I was trying to be proactive because, for me, this is a change both physically and mentally. My therapist isn't well informed about wls and I think she has some prejudices about it.. In the meantime, the psychiatrist won't give clearance and has stated that she wonders if there is a larger issue I'm trying to conceal or if I'm just not willing to follow through.

The psychiatrist is "the doctor [who] required a letter or phone call...?"

The therapist doesn't need to be well-informed about WLS nor is any prejudice she may have relevant to her recommending it for you. The purpose of the psych eval is to show the insurance company that you understand the risks of surgery [nb: all surgeries have risk]; that you have realistic expectations of surgery; that you comprehend that you are the one who must do the proper work in order to lose and maintain weight loss and that the surgery is an aid toward the ends; that you are capable of comprehending and following instructions from the surgery practice; that you are motivated. Very simple and straightforward. You, unfortunately, are tied to the present therapist, as I'm sure you don't want to start anew and thereby delay for several months. Also because the Big Jerk Psychiatrist has said you may be trying to hide something. If I were you, I'd want the therapist to tell the BJP that's she'd have responded to her sooner except for time constraints. That will cover your tush.

My rant is that the surgery practices and the insurers make such a kerfuffle about such a simple requirement. The patient ends up paying several hundred to some BJP for no good reason. Patients must find out whether the insurance company requires a letter of support from a psychiatrist who doesn't know the patient or whether they will accept a recommendation from the patient's own therapist who has some sort of license (PhD in clinical psychologist; LCSW; whatever other, depending on the paient's state). I had surgery six years ago. My own therapist, who I'd been seeing a year or two at that time, wrote a seven-sentence letter, two sentences of which were "I have been seeing Ms. X ..." and "If you need any other info...." Five sentences of substance and I was in, or at least the five didn't keep me out. Of course it may be that insurance companies have toughened their requirements since my time, but how bad could it be. It's also likely that there are differences from one company to another. Nevertheless, the auxiliary industry of BJP's can't possibly be necessary in all instances, can it?

[melyssafaye 181]

First, I was on a waiting list to see the Psychiatrist but finally was able to get an appointment on Feb 4th. The doctor required a letter or phone call from the therapist I have been seeing for the past 8 months in order to finalize the clearance. Other than that, she is more than happy to sign off.

The psychiatrist is "the doctor [who] required a letter or phone call...?"

The therapist doesn't need to be well-informed about WLS nor is any prejudice she may have relevant to her recommending it for you. The purpose of the psych eval is to show the insurance company that you understand the risks of surgery [nb: all surgeries have risk]; that you have realistic expectations of surgery; that you comprehend that you are the one who must do the proper work in order to lose and maintain weight loss and that the surgery is an aid toward the ends; that you are capable of comprehending and following instructions from the surgery practice; that you are motivated. Very simple and straightforward. You, unfortunately, are tied to the present therapist, as I'm sure you don't want to start anew and thereby delay for several months. Also because the Big Jerk Psychiatrist has said you may be trying to hide something. If I were you, I'd want the therapist to tell the BJP that's she'd have responded to her sooner except for time constraints. That will cover your tush.

My rant is that the surgery practices and the insurers make such a kerfuffle about such a simple requirement. The patient ends up paying several hundred to some BJP for no good reason. Patients must find out whether the insurance company requires a letter of support from a psychiatrist who doesn't know the patient or whether they will accept a recommendation from the patient's own therapist who has some sort of license (PhD in clinical psychologist; LCSW; whatever other, depending on the paient's state). I had surgery six years ago. My own therapist, who I'd been seeing a year or two at that time, wrote a seven-sentence letter, two sentences of which were "I have been seeing Ms. X ..." and "If you need any other info...." Five sentences of substance and I was in, or at least the five didn't keep me out. Of course it may be that insurance companies have toughened their requirements since my time, but how bad could it be. It's also likely that there are differences from one company to another. Nevertheless, the auxiliary industry of BJP's can't possibly be necessary in all instances, can it?

The psychiatrist is actually nice and works with the surgery center and is a psychiatry professor at the university (UIC). She said she just needs to find answers to three questions:

1- do I understand what the surgery is.

2- am I competent to give consent and have no mental issues that would make me unable to give sane consent

And

3- do I have the capacity to understand and follow post op plans.

She says I'm fine and she will give clearance with no hesitation. However, since I've been seeing a therapist for some time she wants to touch base with therapist to make sure there aren't any outstanding mental issues or concerns. That it's just a formality but since ins pay therapist they'll want to see the agreement.

It's the therapist who is being a jerk and holding things up. I think because of her prejudices about wls. I explained about the three questions but she kept saying that I may have issues after surgery. Like dealing with unwanted male attention or coping with stress without food.

I am 42, low Bmi 38.9, healthy aside from hbp and apnea. No history of sexual trauma or mental health problems.

[WLSResources/ClothingExch 3,444]

@@melyssafaye ==

That's good. I didn't get any of that from your initial note, especially not from the part about the psychiatrist saying you may be hiding something.

Whew, the therapist needs to go, but not right now. The points she raises about fear of male attention, et al., come up in the forums often. The important thing, though, is that your only response might be "I don't know how I'll react and am willing to find out when presented with such situations.....There are lots of resources to help learn to deal with stress, including WLS support groups both in-person and online (you already know of one!); books/recordings/etc.; hobbies; exercise (exercise really does help to relieve stress).....Dear therapist, you're raising concerns about situations that might exist regardless of the method of weight-loss. I am motivated to lose weight for my health, my future and my belief in myself. Surgery will be a tool for losing and maintaining forever after. If I find that any of the concerns you're speaking about do arise, I will have you and many sources of support to cope and learn to conquer on my own." All in your own words from your own mind and heart, of course.

Once you have what you want from her, send her to me. I'll slap her, the negative beech.

[VSGAnn2014 12,992]

So sorry you are struggling with this.

I am in therapy -- started before WLS -- to make sure I had all the resources I needed to be successful.

My therapist is great. He would NEVER act like this. In my very well informed opinion, your therapist is unprofessional and (to use the technical term) really jerking you around.

So glad you're addressing this and getting it handled. If you determine later that you'd benefit from therapy, perhaps the psychiatrist you've been dealing with (and has been so helpful) can recommend someone else.

[melyssafaye 181]

Thanks for the support! I'm glad you found someone that you can work with. Having a good patient/therapist relationship is so helpful.

The psychiatrist recommended herself if I have any issues or need someone to talk to about weight loss or issues that may come up. I think I'm going to take her up on the offer ????

[Careysgirl 20]

Find out from your surgeon if clearance from your psychiatrist would be sufficient?

[songsmith 334]

Did she charge you for the appointment where you had to come in to receive a letter she didn't provide? If so, I'd present her with a bill demanding the money back!

This is disrespectful and unprofessional behavior. I have a long-term therapist, so I realize we build bonds (and also dread exposing ourselves all over again to someone new). In this case, I must say it doesn't sound as if she has your best interests at heart. Perhaps it's time to find a therapist who does. You're already aware of your issues (or many of them) by now, so you won't need to start from scratch. I know that won't help you much in your current predicament. Maybe if she realizes she'll lose the weekly (biweekly whatever) session fee she'll pony up.

[CBT 450]

If she is licensed, I would contact her board.