Question:
why do I have to pay upfront for psych evaluation with Dr. already in my hmo network

My surgeon wants me to pay for psych evaluation wit Dr that is already in my hmo network, is this legal? can I just pay my co-pay and let the insurance pick up the rest!! or can I choose for my pcp to refer me instead of my surgeon I dont have 300.00 laying around like that. I live on a tight budget!! that will break me!!    — FREIDA P. (posted on December 29, 2002)

December 29, 2002
Psych is usually not PCP driven. But they are often listed in your network. If the psych is in your network your are only subject to your copayment and you would not need to pay your surgeon for your psych eval. Hope this helps. I would call my insurance company.
   — Jeana S.

December 29, 2002
I believe that most HMO's do require your PCP to give you a referral to a psychiatrist as they are an MD. You can go for counseling with someone other than an MD without a referral.<p>I've been perplexed by what I have been reading over the past month. Most surgeons require the psych consult, which is specifically for WLS, before submitting for approval. Yet if you do not get approval then technically the psych eval might not be paid because it related to the unapproved WLS. It all comes down to how the referral is written and how the psychiatrist codes the bill. I was able to avoid all of this because I was already working with a psychiatrist and he did my eval without seeing me - so no cost. One loop hole here might be if your insurance company requires the psych eval in order to consider you for WLS then they would cover the eval except for any co-pay you have. If it's only the surgeon that requires it then it could be a hassle. I'd start by asking your PCP to refer you. That way you might be able to avoid the full charge. Good Luck!
   — zoedogcbr

December 29, 2002
The psychologist think that the insurance would not cover it. But they do in fact cover it. It is all how the present it. If you tell the psychologist that it is an assessment for gastric bypass surgery to see if you are mental fit to undergo surgery than it is cover and you are only responsible for your copayment. Make you appointment and when you see the Dr. explaine to her that it should be cover by insurance, and you can also and confirm with your mental health department. The receptionist always says something different, plus they based their facts on the norm when in fact everyones policy is different. They told me the same thing and I had my psychologist call while I was in the office and they confirmed that it is in fact covered. I have United HealthCare PPO and my sister has Humana and we both were covered. I have had them pay for testing of my oldest daughter for attention deficit disorder and was told that they do not cover it and it was covered. If it is not covered then ask your doctor to work with you and have you visit for 3 sessions and that will cover it also. I did one session and completed a 50 questionaire that I returned within the same week. I return the follwing week for a session to review the outcome of the questionaire and was presented with my assessment notification for my surgeon. Best of luck.....
   — Elsa F.

December 29, 2002
Excuse my error it was a questionaire of 500 questions...I did have to get authorization to the see the psychologist. They authorized me 6 visits and I only used 2.
   — Elsa F.

December 29, 2002
I let my PCP make me an appointment with a Psycologist - I even asked if she accepted BC/Bs PPO and was told yes. After the Psych Eval, I was told by them that my BC/BS would NOT cover it and if I wanted the Psych Eval sent to my Surgeon, then I had to pay for it. Since I wanted it I sent the money -- then I found out that the Psycologist told them she didn't recommend me for surgery until I had Theraphy - ?Coping Issues. I made an appointment for a 2nd opinion and that Dr. also asked for money up front. I don't know if I can get any of this money back - but someone is getting rich off me. I say get it in writing if it's covered or call the Insurance Co. yourself.
   — Sally P.

December 29, 2002
I discovered there is a SEPARATE deductible for psychiatric, from the medical deductible, and that may be why you have to pay up front.
   — Darlene P.

December 29, 2002
I agree with the first poster. Call your insurance company and ask them. If you are in an HMO, you should not have to pay anything more than the co-pay to see any provider who is in network. I am amazed by the number of people on this site who have been asked for up-front money when they are dealing with in-network providers. I had one doctor ask me for money up front and when I asked about it, discovered that he has two corporations. He has one that he uses for his non-WLS surgeries and it is contracted with my insurance company. He has another for WLS which is not contracted with my insurance company. Needless to say, I found another surgeon.
   — garw

December 31, 2002
If someone wants to see the psych that my weight loss program uses, you have to pay $200 upfront and then file a medical claim yourself. Well I got a referral from the surgeon to another psych in my network and I only had to pay my copay of $25 for a psych visit. call your insurance and the surgeon to see what they recommend.
   — Sarah C.