Please help!

mrsgriffin2u · 12-18-2007, 09:50 PM

:help:

So I'm having a heck of a time trying to find someone to do a Psyc consult by 12/31 and my insurance (Cigna thru Verizon Wireless) stops covering WLS as of the new year.

I keep getting different answers from every Cigna rep I talk to, so I was wondering if any of you are in the same boat... Are any of you pressured to get everything started before 12/31? I've already had my seminar, meeting with the surgeon, meeting with the nutritionist, and have started my 6 month physician monitored weight management program. I'm freaking out at the thought that I've already mentally prepared myself for this surgery and now no one can fit me in to make sure I'm not crazy! This in itself is going to drive me crazy!

I started this whole process in December to shortly find out afterwards that WLS isn't going to be covered, but I can be "grandfathered" in.

Any suggestions?? Or words of encouragement?? LOL

:faint:

juliegeraci · 12-19-2007, 07:24 PM

mrsgriffin, I would ask your surgeon's office for a list of phsyciatrist that they use. If they aren't on your plan I would pay out of pocket. It shouldn't me more than a couple hundred dollars. It will be well worth it to speed the process up. Good luck.

kacee · 12-19-2007, 07:25 PM

<p>Ask your surgeon if the can recommend a psych. Then call and see if they're on CIGNA, or just get the CIGNA provider list and hunt down some folks in your area. It's not like this is going to be your life-long doctor or anything...you just have to have an evaluation. Call them and see if they do psych evaluations for bariatric surgery candidates and ask what it entails.</p>

mrsgriffin2u · 12-20-2007, 12:03 AM

Thanks for the recommendations guys! I've tried to call around, but the issue is finding someone to fit me in within the next couple of days and no one has available appointments... I guess the Holiday season is not the best time to want a psyc evaluation huh??

I called Cigna again today and they told me that can't answer the question "Is it a requirement to go to a psychologist prior to 12/31?" My thing is - if they can't tell me it's a requirement, how can they deny me? Obviously it's not documented that it is a requirement. I'm just nervous about playing the whole insurance game.

Ugh... I sure hope that all this stress will result in a thin, healthy, worth-while body! :)

010308 · 12-20-2007, 12:33 AM

As a former Customer Service Rep for a medical insurance company (not Cigna), here are my recommendations to you:

Call Customer Service and ask them if you have to have the psych eval by 12/31/07 in order to be grandfathered for the surgery. If the CSR tells you that they cannot provide that information to you then ask to speak to the supervisor. Explain that you are having difficulty getting in to see a mental health provider due to the holiday's and you really need to know if you have to have this by the end of the year in order to be grandfathered. No matter who you end up talking to be sure you note the date, time, the person you spoke to and ask them if they can provide you with a tracking number that is a reference to the conversation you just had with them. You will, of course, be happy to wait for that while they track it into the system in order to provide you with that information. I'm sure not every medical insurance company uses tracking numbers... but I would bet most do. If the CSR or supervisor tells you that s/he cannot answer your question ask them who can. I'm thinking that the reason that they can't answer this question for you is because Verizon is a large group and probably makes their own benefits which Cigna probably just administers so it is going to be up to Verizon to decide how these benefits are going to read next year. If you really can't get any answers from Cigna then find out from your HR person who the medical benefits consultant is for Verizon and contact them to go over this situation, they may be able to provide you with more information then Cigna can. Be sure you get names, dates, times, what they said. Make specific notes so that once it's all said and done that they can't go back and tell you there is no record that anybody told you that.

If you find out you must have the psych eval before the end of the year and your surgeons office can't tell you who to go to that can get you in before the end of the year then I would suggest asking if they can provide you with a list of questions that are commonly used in a psych evaluation. When I had my psych eval I used someone that I had been to previously and I got a copy of the psych eval that is used by the facility that I wanted to go to. It's possible you could even find the psych eval questions on-line somewhere, although I don't know this for sure. Once you have a list of general questions you will need to answer then I would take the phone book and explain the situation to every mental health provider listed in the yellow pages until I found someone that could get me in before the end of the year... one note, double check with your insurer if they have to have a specific degree (psychologist or psychiatrist or any mental health counselor). I cannot imagine that if you have already started this process, and they have said you can be grandfathered, that they wouldn't grandfather you just because you couldn't get in to have your psych eval before the end of the year.... but you never know.

Best of luck to you!