Question

[pippinje 0]

My supervisor is going through the process of getting approval from the insurance company for the band. I thought I would post this question here since in January I start on the type policy and want to know what needs to be done so I have a few hiccups as possible.

Our insurance requires a psych eval as one of the tests to be submitted for approval. Well, to have a psych eval, they require "precertification". Well, the psych's office submitted this to the insurance co and they denied it?

What's up with that? How can they require it for lap band approval but deny covering it?

Anyone have any thoughts?

[abeaher 0]

I was told by my psych doc that most ins. will cover part of the consult but not all, meaning they will cover the consult itself but not the report that the psych has to type up to be submitted by your bariatric surgeon to ins. He said the key to getting them to cover the small part of the consult is when you call for precert you HAVE TO SAY that you need a consult for "weight related issues" ie. depression, not a consult in preparation for bariatric surgery. He told me that this would get the precert but I would have to pay out of pocket for the report, which was $150 plus my copay for the small part that they would bill ins for. so I basically would just be paying for the whole thing anyways. Hope this helps, you know it is all in how you word it with ins.

[antsmith101 0]

It all depends on the type of insurance, I have read alot people had to pay the full 225-275$ to see psych. I was lucky that my Blue Cross of CA covered psych visit and only had to pay 20$ under Health and Wellness.