How do you appeal PHYC EVAL?

My insurance bcbs hmo says denied as not medically neccessary due to lack of phychological clearance.... If you can only use one phyc eval... and he wont clear you how do you appeal it? I was so stupid to send this in beleiving he sais i was a good canadite and and he saw no problems..... is an appeal possible with this???? i will call dr. duncan office tomorrow but wanted to see if i could get someone that has been thru the phyc appeal to hopefully give me some encouraging news or am i just tottally screwed!!!!!!! kiwani

If you are in the metro Atlanta area, call dr. Gary Santavicca's office and see if they will see you seeing as how you were seen before and not cleared. I say this because he recommends everyone for weight loss surgery, but sometimes he does it conditionally that you continue therapy with another therapist. At least if he said that, you could still have the surgery. I don't know that it would matter that you had already had an evaluation previously. Christy

Kiwiani, You need to read my profile, and it will tell you what I had to go through to get my insurance to approve my psych eval. Your doctors office (who I do not like, and use to be their patient) should give you the specific codes in which you pcp will request a medical referral. It needs to be medical referral not mental referral. You by no means want a mental referral in you medical records if it is not necessary. That will screw you up in the future. Just read my profile and you will understand. Your doctors office should be guiding you through this process and advising you more than they are. Good Luck Diane

Diane, dr. duncans office did not refer the phychologist.. my first surgeon did.. bcbs said i can get another one and dr. duncans office gave me the numbers to call one of them , there are five on there.. hopefully one of them will get it done, hope to know more tomorrow... this has been a night mare with this phych. but it isnt dr. duncans office fault. i did this before i went to them.... thanks kiwani