Insurance Help Needed

OK guys, finally heard something, well a little bit from my insurance today. It wasn't a denial so I guess that is a blessing. But they are needed additional info. They wouldn't release any of it over the phone but they did say Psych. Eval is one of them. They are sending a letter with all their other requirements. I have no clue who to use. Does anyone in the Jackson area have any suggestions? Liv-Lite said for me to get on it asap since psychologists usually are backlogged. Will I have to pay for it upfront and how much does it cost usually? Sue

Hey Sue, Our own James Gilbert here on the board does them. He did mine. He's here in Meridian, but he has a great price !!! And you can get it done quickly, without alot of back log. Hope this helps !!! Tammy

Hey Sue... My insurance required proof of support group meeting, nutritional evaluation, and pschiatric visit before they would even review my case. Once they got that they decided they needed proof of supervised diet. Once they got that they decided it wasnt sufficient. Then I sent them an angry letter and copied my benefits coordinator and New York State Insurance Commisioners office. I was approved 5 days later. Insurance is tough. I think every insurance is different too on what they require preop.... My insurance now requires sleep apnea test, proof of supervised exercise program and proof you have been on dr prescribed weight loss medicine. Once you get those requirements from them... get busy getting them what they need and as much info as possible. As far as shrink goes I had mine in Hattiesburg and it was very expensive. I wish I would have known about Dr. Gilbert. I hear good things about him... and I am not just saying that...

Hey Sue, I had mine done in Meridian. Lucky for me my ins. paid for mine so I don't know about the price. Not alot of help but just wanted to let you know it want be long. No denial is gooooooddddd news. Becky

Hi Sue, sometimes insurance even covers it, you just have to probably pay in advance and then try to get it reimbursed. ( One estimate I had gotten was around 450.00, you may want to check around! ) I was lucky, in the end, my insurance covered it 100%, including psych eval and dietician. I'm on the coast, so I'll be of no help to you, just wanted to let you know we're all here for you during your wait, and dont let anyone discourage you. It can be a lengthy process, and some of us have been thru it just to tell you, it's SOOOOOOOOOOOO worth the wait !! Good luck to you and keep us posted ~~Andie~~

I am going to comply ASAP. I think using Dr. Gilbert will be the quickest way. I do not, however, have any medically supervised diets under my belt. My Gyn did give me Xenical once and it didnt work. But as far as medically supervised diets, I dont have that. But I think I have an ACE in the whole. My insurance "mistakenly" (they said) sent me a letter indicating that all they required was me to meet the NIH pre-requisites of morbid obesity, which I do. So if they get too ticky, I think I can hire a lawyer and win. When I called them to get more info, they told me, oh no, you should not have gotten that letter, as of yesterday (the day before they sent my letter), they no longer go by those rules. But hey, they should not have sent it. Sue

You mean they sent it to you and it's invalid and outdated? Yeah that sounds just like an insurance company, trying to find a way out of having to pay up. If they require you to have a supervised diet, I'd recommend to go through with it and try it. Because most of us have already tried the supervised diet before, you may see others get approved within a few weeks, but from what I'm gathering, this is pretty much a standard requirement and it may just be more economical to go with the diet attempt rather than having to hire a lawyer. From my experience talking to others, the main points for approval are the diet attempt ( supervised, sometimes 6 months ), visit with a dietician, psych eval, some also require sleep testing ( some don't, mine didn't), an array of blood testing, some also include pulmonary testing and an EKG is pretty much standard requirement. So you see, give yourself time to do all the things they request and they can't deny you. You've waited a lifetime for this surgery, what's another 6 months? We're here for you ! Keep us updated on your insurance progress It'll all work out for you in the end ~Andie~

Holler if you need Psycho Doc's (aka Dr. James Gilbert) number. He did mine too - even tho I didn't need it thru Keesler! Smoochies Arlies

Hey Sue, I also used Dr. James Gilbert here on the board. I would recommend him to ANYONE. And he got the results back in record time. and he was an all around NICE GUY ! !! He also is very reasonable priced. Joyce

Hey Sue, Dr. Gilbert did my phsyc eval also...He is wonderful and I would recommend him highly to ANYONE!!! Angie Bea