My response letter from BCBS - anyone seen something similar?

[Guest guest]

I sent my letter from Dr. R to BCBS last week. Today in the mail I

received this reply from them:

" This letter is in response to a recent inquiry regarding available

benefits for the surgery listed above. The submitted information,

however, is insufficient to provide a determination. Therefore,

please submit the following.

BCBSUnited of Wisconsin policy requires a pre-surgical psychological

evaluation to determine the absence of contradicting psychiatric

illness (bullimia, major affective disorder, alcoholism, or

psychosis). A psychological evaluation will also determine whether

there is a good likelihood of compliance as evidence by at least a 40

pound weight loss using conventional methods and no more than

moderate

current psychological stress.

Upon the receipt of the additional information, we will continue with

the review for available benefits. It is requested that the above

information be forwarded to us within ten (10) working days in the

enclosed addressed envelope. Thank you for your cooperation. "

Has anyone seen anything like this before? I haven't contacted my

PCP

yet - but I wonder if it's even possible to get a psychological eval

within 10 days? I've definitely lost 40 lbs - but not at one time..

to me, this is what they want...???

Any comments, suggestions, anything would be greatly appreciated.

Thanks

Waunakee-WI

[Guest guest]

Yes, that is actually good news. It means they are trying to qualify

you for the surgery and their criteria to prove that the surgery is

medically necessary requires that you have a psychological evaluation.

That is a *very* standard part of many insurance company's criteria.

Get the psych eval done, send it to them. BEFORE you send it to them,

however, call them and get the name of a person to send it to and send

it to them by certified mail so you can prove they got it.

Kind regards,

Weeks wrote:

>

> I sent my letter from Dr. R to BCBS last week. Today in the mail I

> received this reply from them:

>

> " This letter is in response to a recent inquiry regarding available

> benefits for the surgery listed above. The submitted information,

> however, is insufficient to provide a determination. Therefore,

> please submit the following.

>

> BCBSUnited of Wisconsin policy requires a pre-surgical psychological

> evaluation to determine the absence of contradicting psychiatric

> illness (bullimia, major affective disorder, alcoholism, or

> psychosis). A psychological evaluation will also determine whether

> there is a good likelihood of compliance as evidence by at least a 40

> pound weight loss using conventional methods and no more than

> moderate

> current psychological stress.

>

> Upon the receipt of the additional information, we will continue with

> the review for available benefits. It is requested that the above

> information be forwarded to us within ten (10) working days in the

> enclosed addressed envelope. Thank you for your cooperation. "

>

> Has anyone seen anything like this before? I haven't contacted my

> PCP

> yet - but I wonder if it's even possible to get a psychological eval

> within 10 days? I've definitely lost 40 lbs - but not at one time..

> to me, this is what they want...???

> Any comments, suggestions, anything would be greatly appreciated.

>

> Thanks

>

> Waunakee-WI

>

>

>

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