OSU and Psych Eval question

Hi there-- I haven't posted on the board before, but I have been a member and I do come here to see what people are talking about etc. I saw a post a few weeks ago regarding the psych eval with OSU (specifically the cost and that Aetna wasn't covering it). I wanted to put this out there to see what other experiences there were. I am currently doing the Living Well program in preparation for insurance approval. The Surgery program called me and told me they were setting up my psych and nutritionist evaluation appointments. Great, I think. Then I get the call from the Psychologists office to say the appointment is set up, we contacted Aetna and its not a covered benefit, so that will be $415 when you come to your visit (they left a voicemail at my work number I haven't had a chance to speak with anybody yet, will be doing that Monday). I'm saying to myself, "What?!", 1. I don't have a spare $415 2. Why can't I see a psychologist that my insurance would cover 3. Why wasn't I told about this potential cost in the first place, If I had know at the beginning of the year when I really started getting into this seriously, I could have at least been saving money. 4. I'm feeling that this is a bit of a set up now. First the money for the Living Well program ($300) and now this. I know I have heard good things about the Dr.'s at OSU, but this certainly seems like a money making machine for all of the associated departments. Anyway, with all of that venting, I just wanted to see what anyone elses experience had been in regard to this, either with Aetna HMO, OSU, or both. Thanks for any thoughts. Laura

Things might have changed but when I went through the OSU program I was able to go to a local psych for my eval, OSU faxed them all the information they wanted me evaluated for. I was a college student and was able to have the eval done by the psych in the counseling center. I am now however, in the situation where my new surgeon wants me to see the psych she has all her patients see to clear me for hernia and plastic surgery. My insurance did not cover it and I told her I would not pay $200+ for something I had already done for WLS...luckily I have Medicaid as a secondary and was able to see one of her residents for the eval...thank goodness because she mistook everything I said and did not clear me for surgery...glad I didn't pay to be turned down. So now I am suppose to see my own psych, but my surgeon wants me to go back to hers in 3 months. Hoping I can use Medicaid again...and just keep my mouth shut this time...so nothing can be misinturpreted.

hi, yes i know how u feel i felt the same way 415 that i wont get back for a phys that they make u go to, it has to be him no one else, so if he is not in network, and i dont think he is in anyones next work then ur stuck because if u dont see this guy then u can not get into osu program and the 50 for the med gem i was way complaing however, u can file a claim and hope u get money back from ur insurance i dont know what ur terms are for out of network coverage more or likey it will go towards ur decitable sorry i cant spell, but what 500 for your health the rest of ur life, best of luck

Laura....Laura....Laura..... I feel your pain...I am the one that posted awhile back about the psych eval. I was told that Dr. Kramer is the ONLY psych doctor contracted thru OSU's bariatic program and that I had to see him.........and only him.....no if's and's or but's. I have Aetna and they don't cover this doctor........so I had to pay the $415 day of appointment...they will NOT take payments at all!! Believe me, I asked. I know its frustrating, it was for me, especially with having to pay the $300 for the Living Well class and NOT being told about this $415 up front for the eval. I did suck it up and pay the $415, but had to reschedule my appointment a week later till I had the money.........I'm like you, i don't understand why they don't tell you ahead of time so you can save........its frustrating...I know!! BUt its Dr. Kramer or you have to go to another Surgeon/Program. They do bill Aetna, but its at Out-of-Network charges, my out-of-network is $350 deductible and then they pay only 65%. I may get alittle bit back, but not much at all! It sucks because your not even guarenteed approval, but Aetna is pretty good about it if you have everything they ask. My stuff was either sent Friday or will be sent tomorrow to Aetna..........so its been a stressfull weekend. BUt i have to keep the faith, what else can you do???? Good luck with what ever you choose to do and sorry you are going through this, I was there the beginning of the month.....it sucks!! Tabitha

Hello... I just finished the living well program and I will be finished with the 4 week pre op program on Wednesday... I love OSU, BUT there are ALOT of hidden fees... Yes you will have to pay the $415 for the psych evaluation... I have Aetna and they dont pay it... OSU doesnt let you go anywhere else except through them, so either you pay it or you don't go through them... You also have to pay the $300 for the living well class... THEN once you are approved by your insurance you have to pay $100 for the 4 week pre op class... Now on the other hand, OSU was wonderful to work with... they did all the insurance approval and have been so helpful and informative... so I have paid about $800... to me it was totally worth it... Hang in there and dont get frusterated... God will provide... If there is a will there is a way!!! Take care and God Bless

Paula, You are a breath of fresh air! I am so glad to see someone see it in a positive light. OSU is a wonderful program. I explained to Tabitha the whole thing, and she understands, but I know it IS frustrating. But look at is this way...without this surgery, how frustrating will your life continue to be? How many times over are you going to reap that 800$ investment for the rest of your life? You can't have something for nothing folks. These guys have bills to pay too, and believe me I wouldn't be a doctor now for anything in the world. They don't just make huge paychecks every month, and part of the problem is stemming from the insurance companies. I will tell you be thankful that you only have to pay that much. Because if you are an employee of OSU and have our insurance here's what we have to pay: 30% of the cost of the surgery (our insurance only covers 70% now) A separate $400 deductible 250$ inpatient co-pay We have to take 1 year of living well which I believe rounds out to be about A$1200 (when Earl took had it, the cost was 650$ for 6 months) Plus a psych eval Plus a nutrional consult Plus the 4 week preop teaching which we have to pay for as well which it cost Earl about 150$. So, round about 4500$. I am glad to see someone say they are thankful for what they have to pay. We have to remember this is ELECTIVE surgery. And if you were looking into any other elective surgery, you would surely expect to cover most or all of it. Aetna doesn't like to pay. So, they only way they can garuntee they are going to get anything is to have you pay upfront. They pretty much want the docs to work for nothing. You also have to remember that out of that 415$ comes overhead, staff salaries, etc... I don't think anyone out there would want to work for free. Am I right? That and the fact they switched to Dr. Kramer was for continuity. He is experienced with wls patients, he knows what to look for and what to check into. OSU wants their patients to be successful. Because if we aren't successful, insurance companies won't cover us at all. It's all about you. It's about your success. Aren't you worth it? So, thanks again Paula. I am happy to see such a great positive post about a wonderful place. I love OSU, I love working there, I love the fact that I had my surgery there, and I love the fact that it has lead me to meet so many wonderful people! I haven't forgotten.... March 29th!!! BIG HUG!!! Val

Hello. I also have Aetna and am in the same stage as you. I start the Living Well program tomorrow. I spoke the Shanna (Shannon?) at OSU Bariatric and she said that she has a meeting about the issue of the Psych evals not being covered by Aetna. Her meeting is on 3/29. She advised me to wait until after her meeting. They may be adding a new doctor or maybe making a special price for those whose insurance will not cover the visit. She doesn't really know what they will decide but they are working on it. I have Aetna EPO. I am worried that they will not cover the surgery. My policy only covers 50% up to $10,000 anyway. I am also working on deposits. If your policy is the same I might have some advise for you on deposits, as well. I would love to hear back from you. Shellie