Question:
IS IT NORMAL THAT YOU HAVE TO HAVE SLEEP STUDY AND PYSCH EVAL BEFORE INS APPROVAL
I am going to OHSU in Portland, OR. I Had my first consult with the NP and Dietition. I was told that they would be submitting to INS for approval but it maybe iffy because of the requirement to have 1 yr supervised diet with a dr. I just got a call from the office girl and she said I would have to have a sleep study and a psych eval before they would submit the paperwork to the ins.. even though the sleep study and psych eval is not part of the qualification for approval through the insurance.. has anyone ran into this before.. or am I being to sensitive about this — judchastain (posted on July 21, 2005)
July 21, 2005
I am pre-op right now and the WLS office told me they believe that my
insurance provider requires it so they want me to do that now. I don't have
to do a sleep study for the Doc or insurance though I know that it is
common for people to have to have it done. Good luck to you!
Simply, Cami
— Simply C.
July 21, 2005
If you have sleep apnea the sleep study can help get you approved:) The
psych exam is there for your safety too.
— bob-haller
July 21, 2005
Hi- do all the testing- its to your benefit. I thought I had no problems-
turns out- I have stones in my gallbladder and they discovered an ulcer. I
also did the sleep study- was not required- but have some sleep apnea.
Thease things, when presented to the ins company by a PCP who writes the
your letter correctly and includes the weigh ins/weightloss - will most
likely get you approved. If you look for reasons NOT to do it, then you
give your ins. company easy reasons not to approve you- at a time when ALL
ins companies are looking to go out of network on WLS. One other thing-
the monthky weighins - is to see if you can lose weight. My PCP advised me-
they look to see if you lose enought weight- so as NOT to pay your claim. I
went through the 6month weigh in and lost only 10 lbs. Aetna approved my
insurance today.
So my advice to you- is find out exactly what the details are to get
approved- your surgeon can tell you -and do exacly what is detailed in that
bulletin. I did all of it with no guarantee- Aetna is notirious for denying
claims- and the first thing they asked for- my surgeon told me - was the
6month weigh in. So Good luck and try to get it done before 1/06, he first
of the year is when most carriers modify their requirements (read make them
harder) for approval.
Best wishes,
Donna
— nybabe
July 21, 2005
I had my surgery April 04 and the psych eval was MANDATORY for my
insurance/surgeon (not sure which LOL) but I also did the sleep study to
help me out. I had a feeling I had sleep apnea and figured by taking the
test if I had even a small case of it, that would help in my insurance
approval. I say do it, don't take it personally, in the long run both
thing could help you win your approval!
— cedsangel
July 21, 2005
My hospital required the sleep study. If you have sleep apnea, they want
you on your CPAP right after surgery. It's for your safety as well as
theirs. My insurance required the psych eval. They want to know you have
the right expectations and that you don't have past history of eating
disorders.
— Kathy C.
July 21, 2005
It's very common for surgeons to ask for several tests that insurance
doesn't require. My own asked me to have an endoscopy and nuclear stress
test in addition to the psych eval and the sleep study. Remember that
bariatric surgeons work with very high risk patients who are making a
permanent decision about their futures. A doctor who doesn't cover all the
bases is not doing you any favors!
— Beth Barnhill
July 22, 2005
This is quite normal in most situation the psych evaluation is to help make
sure you understand the life long change and the sleep study is to make
sure you are not one of many who has sleep apnea. Sleep apnea is very
prominent problem amongst those of us with obesity problems. Infact I am
glad to hear that the Insurance company is taking it upon themselves to
make sure your surgery will be successful.
Hope this helps. Blessings on your surgery.
— jstplainwyrd1956
July 22, 2005
Don't worry about all the tests that they are going to give you, especially
the psyche evaluation. I have been seeing a therapist and psychiatrist
regularly for 10 years (since my last divorce) and I figured that they
would go ahead and perform my psyche evaluation and they refused to because
they don't want to be held responsible for any emotional conflicts I may
have AFTER the surgery. I was in complete shock that they wouldn't support
me on this, but now I have to travel 190 miles out of town to have a psyche
evaluation at my hopefully surgeon's office. It is just something they ask
for because they don't want to be responsible if you freak out after the
surgery (they can blame the psychiatrist, I guess). Anyway, I look at it
this way....if I am going to freak out after the surgery, it's because I
don't know what thin feels like and I will be literally walking on air as
the pounds come off, right? Don't sweat the small stuff!! In my prayers!!
— Barb
July 22, 2005
Insurance is getting very touchy about approving surgery for the gastric
bypass and require you meet certain criteria before approval (medical
need). The Psych eval is to show that you are ready to make the changes in
your life needed so that the surgery will work for you or to see if there
is an underlying problem that may complicate your surgery such as binge
eating, emotional eating, etc. At Mayo, everyone is required to go through
a Psych eval before even being considered for surgery. The sleep study is
to test you for a sleep disorder caused by excessive weight such as apnea
(lapses in breathing) which will qualify you for surgery. I already have
severe sleep apnea and am on CPAP, so I wasn't required to have one. It
could be they are making sure you have enough qualifying criteria so that
you are approved.
— Atomicspice
July 25, 2005
To the best of my knowledge, both the sleep apnea study and psychiatric
evaluation are insurance company requirements for bariatric surgery in
Pennsylvania. I had a very successful laparoscopic roux and y bypass at
the University of Pennsylvania Hospital on June 3rd and qualified with less
than a 40 BMI based on sleep apnea.
— Linda G.
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