Frustration...

Well, now this is funny! Since the psychologist Dr. C's office uses is not in my ppo, I set out to try and find my own. I called my insurance to get a list of folks to start calling, and verified that this would be covered. They said yes, and gave me some names to start with. Most of them must have been 1 person offices because I got alot of answering machines. This one number they gave me was for a large clinic and I was delighted to actually speak to a real person, and even more delighted to find out that they would do the evaluation. Then the lady asks me if I realized that this would not be covered and I'd be expected to pay upfront. I informed her that actually my insurance was going to cover it because it is something they are requesting. She said "oh ok, well hang on then". Next, the insurance clerk for the clinic came on the phone, and spoke to me as if I was a 2 year old, and said, very rudely, "Ma'am, your insurance is not going to pay for this because it will not have a medical necessity code on it. Any patient getting the gastric bypass has to have this eval, and insurance WON'T cover it!" I tried to explain to her that my insurance WOULD cover it, but she cut me off and refused me an appointment!!!!! Can you believe that! So I proceeded to re-call my ins co and tell them what she said. My ins people were ticked! He said, and I quote..."It's not HER place to decide what is medically necessary - it's MINE!" LOL I was so flustered! So they (ins) are actually going to do the calling for me and then let me know who to make the appointment with. Ain't that nice of 'em? They are all rooting for me! So, hopefully I'll hear from them Monday and get the ball rolling. We'll see! I just had to let you guys and gals know where I stand! LOL Thanks for listening! HUGS Kimberly

hey kim dont worry about it! it sounds like your ins co. is on top of it! And that darn Dr. didnt want your money or your ins's money very badly for them to treat you that rudely, and with the way they spoke to you I wouldn't have went to them if they agreed to use your ins....that was soooo uncalled for! I am glad your ins co. is so understanding! You will have a date before you know it, just keep on keepin on! God Bless, Angie Bea

Thanks Angie - I'm not too down about it. I just thought it was an interesting "turn of events" and probably a new "complication" for the board! LOL Too weird I thought! The only thing I'm trying to accomplish is to get this done ASAP, because I'm really worried about the summer. I know I'm probably expecting too much, and I need to chill, but I have to try....let me explain... I have a small window of opportunity unless I wait until Fall to have the surgery. I'm a minister of music and we have VBS in June, and I have a family reunion - In WISCONSIN! - in July and then my brothers wedding in August! It's all jammed with things that I can't miss. So if I can't get a date bascially in May or EARLY June, then I have to wait until End of August, which puts kids back in school - etc. YUK! I realize that even in May or early June, if I have complications, I may miss something - but at least then I'd have an excuse! LOL That didn't sound right - but you know what I mean. My pastor had the surgery in December and told me to expect to take off 2 Sundays - if all goes well.... So that's kinda where my time line is coming from. In all reality, it really sounds like Fall is a better time for it to happen - and perhaps that's what I'll have to accept - but then the person who is supposed to come and help me at home, can't - etc etc. I really need to chill dont' I? LOL I need to just put it in His hands and go along for the ride.... OK - I'm taking deep breaths now! LOL Relaxing.....relaxing......chilled. HUGS Kimberly

I was kinda in the same situation. I found several who were covered under my insurance, but they all wanted payment up front. I called the insurance and they said it was their option to require money up front. I then called Liv-Lite and they gave me the name of a Dr who had just started in the area. I quess he is still trying to establish himself, as he said he would be more than glad to take the co-pay.

Small hijack..... Hey Pj, I don't think we've met! I am the Queen ! and I am glad to see you posting! Come back and play often! Smooch Arlies

Kim, don't let anyone get you flustered. Those are the times you have to get onto their case, and you did the right thing. I was told by several folks that the psych eval isn't covered because gastric bypass is elective surgery, however, I argued my point with the insurance and said, if you agree to pay for surgery because of my co - morbidities ( diabetes and hypertension to name the main ones ), then this isn't elective. They went on to tell me that they would "approve me for 7 sessions" with a psychologist, and it just depends on how they code the visits. The psychologists office said, they will try to do their best and code it to be covered, and lo and behold, even though I was warned, I may get a bill for it, they pulled it off and my insurance covered 100% of everything, even the dietician who normally isn't covered, because it is related to the surgery and it was deemed medically necessary. So you did the right thing, call back the insurance and have them deal with the non-compliant insurance "specialist" at that doctors office, and don't let them make you pay for anything up front if your insurance says they will cover it. I found that with my insurance ( Tricare, who covers the entire u.s.military's dependants ) there are a few doctors who would rather think twice than lose them due to a dispute. I have turned in a rude physician before and would not think twice about reporting something like that. Go Girl !!! Good luck, girl, and keep us posted on what happens next ~Andie~

Thanks Andie - I look at your pic and just get inspired all over again. You are just too darn cute! HUGS Kim

Well sometimes people (the insurance clerk for the clinic) seem to know all. NOtice I said "SEEM". Had she been a Queen I would have to support her fully and say she DOES know all. But not all of us have what it takes to be the Queen like yours truly, so listen to your insurance folks!!!!LOL Yep, I think you cornered a new market here with this little story! MOst insurance companies react like the clerk and vice versa! Don't despair the insurance will straighten them out!!!! Smooch Arlies PS Dr. G., our very own psycho doc, does the psych evals and charges LESS than the co-pay or at least less than some of the others. Lemme know if you want his number. He is in Meridian....