Insurance Question

I am going on the 31st for my Surgical evaluation, diatician, and psych eval.  When I called for the psych eval they said I would have to pay for it even though they are in my insurance network. Has anyone else had this issue?  Did you get your insurance to pay? The money is not the issue for me but I don't feel like I should have to pay anymore than my copay since they are in network. Is this a different type of psych eval than what is typically covered. Any experience and advise you have would be appreciated.

I was told that I had to pay for mine too (which I did...over $200.)  Scott has the same insurance that I do and he was smart enough to use EAP.  I wish I had done that!  Call your insurance provider (or mental health provider) and ask the question yourself.  Don't be like me...I just said..."okay"  and handed over my money. Good luck! Freddie

Does your insurance have behavorial health in it as well as medical health? Some companies do not get the behavorial health which would include seeing a psyciatrist. I had it on my insurance but my husband didn't and we had the same insurance but through different companies. That may be why they are asking you to pay. You might could ask them if they could submit it anyway and see what happens. Of course they may want you to pay upfront and then if the insurance pays, they will refund you. 

Thanks Freddie thats a good idea. I do have both the behavioral health and Medical.  I called two places and they said they have had issues with insurance paying so they don't even submit it anymore. My issue is they are in network and by contract should have to submit the claim to the insurance company first. I have Blue Cross of CA which when you are out of state they use BC/BS of that state.  I called The Evelyn Frye Center and Athena they are both in the BC/BS network but both said they won't even submit it but would give me a "discounted rate" I sell insurance (although not medical) so it's kind of a pet peeve of mine if someone is in network but refuses to take the insurance.  They have signed a contract to except those patients at the agreed to fee.  In this case they are having patients funneled to them but are trying to charge more than they should. Anyone have experience with these providers?

Try Dr. Victor O'Bryan.  He tests and counsels wls patients.  I see him as many others here.  He is a wonderful and kind man.  He filed insurance.

Wow. That is crazy. I definatley do not understand that. They should at least attempt to bill the insurance if they are in the network and covered. If the insurance company is bad about paying, then they should have to go after them, not you for payment. I am sorry you are having such problems. Can you go to anybody for your evaluation or did your Drs office say you had to go to someone in particular. If you can, try and see if you could find someone else. I hope you get it resolved. I would not like paying for something I didn't and if you have to, then you should get a receipe and bill your insurance company for reimbursement. Of course that will be a hassel on your part to get reimbursed but it may be worth it. Good luck and I hope you get it worked out.

I would contact your insurance provider, because some do pay for the psych eval and some do not.  Mine was in-network, but this type of eval was not covered since it was for WLS, even though they required it for approval, Who gives???  However, 300.00 was worth it for approval!!!

OK I have checked with my insurance which is Blue Cross of CA and they said the eveluation is covered.  I called and talked to Athena and they said they still are not going to file the claim even though they are in network due to the insurance usually not paying. This sucks in that they are breaking there contract with the insurance company but they also know I need this for approval so it's like take it or leave it.  I guess the good thing is it's not about the money to me it's just the principle of the idea.  I know insurance companies are a pain to work with but if you have signed a contract to be in network you should follow that contract. In any case off to my appointments Thurdsday.

I know they always say that this is not a guarantee of benefits, but can you have them send you something stating that they will cover it or ask Athena if they will file it and reinburse you the funds once they pay.  Athena would not be out any money if they didn't and if they do, then all they have to do is send you the money back!!! Another Idea would be to pay Athena and then file the claim yourself, then BCBS could just send you the money back!! Just a few thoughts!! Shelia