Adolfo Fernandez - psych and NUT insurance issue?

 Good morning!  I have an insurance issue with my surgeon. He participates with Aetna, but his psych and NUT team members do not even submit claims to insurance companies, as far as I understand. I have good insurance, with a set out of pocket limit.  Has anyone ever gone to OTHER psych and NUT providers, while still having Dr. Fernandez do the surgery?  How did you handle the insurance/pmt issue with the NUT and psych, if you did use his team members?  Just trying to figure out what my options are; I don't want to pay out of pocket any more than is necessary.  Thanks!  Heidi

Heidi -

I understand your reluctance to spend more out of pocket that absolutely nec. and I don't have experience with your Dr. That said, you may have to use them because generally speaking you are going to need a psych eval and nut workup from someone who has extensive experience dealing with WLS patients. I know that my program (Duke) has a similar issue. I have to pay upfront and hope that the insurance will reimburse. You may want to check on the restrictions before making an appointment with another provider.

Wishing you all the best as you journey to a healthier new you.

Barb

I can't speak to your doc, but I know that mine didn't have any problem with me finding a psych in network who had weight loss surgery evaluation experience.  The nut my surgeon uses is not really part of his practice, they just share office space. That said, I'd tell your surgeon's office and see if they have other options.  In the end, it is your health and your decision. 

The  reason that they expect you to pay out of pocket is that they are not licensed yet.  I had the same problem with my nutrionist.  I knew that my insurance company would pay for mine as I had been seeing a nutritionist for years.  When I asked them to go ahead and file with my insurance company it was explained that the nutritionist was a recent graduate from school and had not been certified by the state and that insurance companies would not pay for the visit.   I saw my own psychiatrist before surgery and my surgeon did not have a problem with that.   When I went to make an appointment after surgery with the nutrtionist she never would return my calls.  I have not seen a nutrionist since I left the hospital.  I am just winging it on my own.    My initial visit before the surgery with the nutritionist was a waste of money.  She spent 15 minutes telling me that I would have to go on a low carb diet--no directions on how to do it and that I would be on Boost in the hospital.   It wasn't until I got ready to leave the hospital that another nutritionist gave me a print out that I should have received before my surgery.    I have an appointment in February to see my former nutrionist. 

 Thanks!  So a degree does not mean they are licensed...that never occurred to me! http://www1.wfubmc.edu/weightlosssurgery/Physicians+and+Staff.htm

No, licensed is a whole different thing.  There is a thread on the Diet and Nutrition message board where I asked the pros there what was the difference between a nut and a dietician and what certifications we should look for.  Check it out, their info was awesome!