CIGNA and Psych Evaluation

I'm posting this here and on the main board, the lap board, the CT board and my surgeons forum and if there's somewhere else to post this, I'll post it there too. I'd like much input as possible while hoping theres no rule against cross posting. Here's the story: I've been sailing along, getting this and that test and all I knew was Cigna was approving everything as these were all referrals via my surgeon Dr. Aranow. Okay...yesterday I received a letter telling me Cigna is not paying my $900 pysch evaluation because there was no approval or referral or somethign to that effect. Anyone else have this experience? Have I done something wrong? How can I rectify this? I can understand requiring a copay, but not the entire amount? Dear heaven, my next fear is all KINDS of bills coming in, with the same explanation. Oh dear!! My paperwork is in for approval so my fingers and toes are tightly crossed while I'm simultaneously becoming unraveled by this. again...HELP!! thank you, Cynthia

For starter, $900 is about $500 too much at least. My doctor suggests a particular phycologist and she charges $200 if you pay by cash for those without insurance. As far as pre-approval, you do have to get pre-approval before seeing a phycologist or phyciatrist. Since you did not, write a letter and appeal the decision saying this is just a step in the wls surgery process and discuss how vague the procedure is. If you are still denied, keep appealing. If this phycologist or phyciatrist is in the cigna plan, signa should still send you how much their agreed amount with the dr is which should be much less - worse case. For example, if in the cigna plan they may bill $900 but the agreed amount with cigna may be $300 and if they deny coverage you would pay the $300, not the original amount. If they are not in the cigna plan you may have a problem. It is extremely unfortunate that the insurance companies are very very vague in how to meet the requirements and what you need to do. Jim

Jim, thank you so much for your advice. I think you're absolutely on the money. Again, thank you for your time and concern. Cynthia

I just completed by psych with Cigna. Had a referral -- but even if you didn't, you should get at least "usual and customary" Have your surgeon write a referral after the fact, saying that he/she recommended the psych but that it was not submitted pre-evaluation. Cigna paid $300 for the initial eval, including an 800-question test, and then $65 for the review of the results with me. The original bill to Cigna from the Psych was $850. If Cigna won't pay usual and customary, go back to the psych and tell him that he should at least bill you only for what insurance would have paid. (Cigna can give you this number if you do need to negotiate)

Hi Nili, I contacted the psych people first, just to be sure paperwork was submitted properly with all codes, etc, and right now, they're dealing with it. But I'm going to call today just to be sure we're getting somewhere. I appreciate what you're saying and I believe they'll be willing to negotiate. It's a hospital outpatient center, the hospital where my surgery will be taking place so I'm feeling hopeful. THank you for your response. I'll definitely be taking your advice should this go the other way, which is always a possibility. Cynthia

one last thing... I received a notice from cigna before they approved my surgery, informing me one of the criteria for approval was a psych evaluation. I forwarded this to the outpatient center for them to resubmit my paperwork. It's important to hold on to EVERYTHING insurance companies send, as in this case they may have made my case. Cynthia