Update to Psych Eval Killed My Insurance Approval
I was recently denied insurance approval due to my psych eval stating
I was too depressed and needed probable treatment. I went back today
to the office of Mr. 180 Pounds, PhD.(I had only gone to him because
his office offers free counseling as an employee benefit where I
work.) I told him that after the insurance company had seen his eval
I was denied. We went over the eval right there in his office. I was
shocked by his misunderstandings of what I had said and how he had
misinterpreted and turned my words around. I’m not going to say that
I know more than he does about psychology but a lot of the “facts” he
had written were not even true. For example he had asked about my
support system. I told him my husband was very supportive but my
mother who had been my main support all my life had had a stroke a
couple of years ago and she could no longer talk. My Dad had always
been the quiet one in their relationship so, even though he is very
supportive of me, he doesn’t do a lot of talking. We have always been
very close without having to be constantly carrying on a
conversation. Anyway, the psychologist put in his report that I was
depressed over the death of my mother and in his summary of diagnosis
at the end of the report he was afraid I had severe depressive
disorder due to unresolved grief since my mother’s death. He also
said that since I was not emotionally close to me father my support
system seemd rather thin. That is just one example of his
misinformation all through my report. I let my husband and oldest
daughter read the report. We all agreed that it isn’t me. The
psychologist said he wouldn’t change his mind about the report
because that would damage his credibility. I told him my only
depression is about being overweight and unhealthy and I was well
prepared for this surgery. He still recommended some treatment with a
qualified counselor-which wasn’t him-he was only an evaluator!! He
also mentions in his summary that, even though we did not discuss my
expectations of this surgery, he was afraid they were unrealistic and
that would most likely detract from me having a successful surgical
experience. (Can you hear the incurance company drooling over that!)
He did mention that he thought I was probably upset with him and he
also said “you probably think I’m full of crap”. He skirted around
the issue for a little while longer while he was probably trying to
figure out how to get me out of his office and I think I heard him
mention getting a second opinion but I had tuned him out at this
point and was already mapping out a new stragedy. He also seemed to
side with the insurance company stating they always like to be sure
something is going to work out before they decide to pay for it. I
informed him that this surgery would cost them a lot less than an
open heart surgery or a recovery from a massive heart attack. As soon
as I walked out of his office-after getting a copy of this report!-I
called my surgeons office for a new appt with their recommended
psychologist.I should have done this in the first place. I am also
going to call my insurance company and ask them if I need to file a
formal appeal or can I just point out the many discrepancies in my
psych eval from this guy and get a second opinion. I want you guys to
know that I am not trying to hide a real problem with depression. If
my eval had been truthful and he had found real problems that needed
addressed I would be happy to go into treatment. I’m not an expert
but I know I am basically a happy person with a good life that I want
to improve and extend by having this surgery. I have received a lot
of help and great advice from you guys and I’d like to pass some
along to those of you who have not yet had your psych eval. It does
count and what you say will be scrutinized. If you are willing to put
yourself through all the hoops and are really serious about having
this surgery isn’t something this important worth paying for! If your
surgeon recommends someone, it is for a reason. They probably have
had a lot of experience dealing with obesity and will understand the
type of depression it causes and will not penalize you for it but
help you in your effort to overcome it. That is what I am hoping for,
anyway. Even if that person is not covered under your insurance you
are worth it! I found out the hard way. Wish me luck for next time.
Gale memeeof6