Bariatric Pre-Surgical Evaluations & Consultations
Why do I have to see a psychologist?
There are very good reasons for this evaluation. First, many insurance companies realize its importance and require a psychological evaluation before they will approve bariatric surgery. More importantly, your entire surgery team of physicians, nurses and dietitians want you to maximize your success - to lose excess body weight, become a healthier person and improve the quality of your life to the greatest possible extent.
Psychologists offer invaluable support in assessing patients’ mental conditions, and frequently counsel patients to withstand the lifelong changes associated with surgical weight loss procedures. It is important that patients have a realistic expectation of the rate of weight loss, as many patients may feel that weight loss will occur immediately after surgery. In addition, although outcome predictors are not completely understood, it is well recognized that patient knowledge, psychosocial adaptation, and motivational factors are important in achieving successful weight loss after bariatric surgery.
The psychological evaluation can help identify your strengths, such as a strong motivation to exercise as your weight is coming off, a complete understanding of the effects of surgery or a supportive marital relationship. It can also help find areas where you might need support after surgery, such as depression or mood swings, lack of family support or triggers for past emotional eating.
A psychologist can often answer questions you might have. For instance, some people are fearful of the surgery itself and may be able to benefit from stress management techniques. There is evidence that people who are relaxed prior to many types of surgery not only heal faster, but also have less postoperative pain. The psychologist may be able to guide you toward techniques which may help with this.
Others may be concerned about future feelings of “deprivation,” such as not being able to eat their favorite rich, high-calorie foods after surgery. The psychologist will help you to understand that these feelings, if they occur at all, will usually be short-lived. And, if you feel the need for a referral for counseling, please feel free to ask. Just remember, the psychologist is part of your “safety net” after your surgery whose primary focus is your ultimate success.
Psychologists are required to answer specific questions about you before recommending you for weight loss surgery. These include:
- Do you understand the procedure and commitment to lifestyle change you are making when you have weight loss surgery?
- Do you have sufficient knowledge, coping skills and other resources to succeed in changing your lifestyle following surgery?
- Do you have sufficient social support to achieve a healthy recovery and improve your quality of life following surgery?
- If you have experienced problems with depression, anxiety, addiction or other psychological problems, are your symptoms under sufficient control and do you have the ability to cope with a major life change?
- What, if any, additional support is needed to make your surgery successful?
The evaluation meets standards set forth by the American Society for Bariatric Surgery and the Veteran’s Health Care Administration MOVE program, as well as general ethical standards set forth by the American Psychological Association.
The evaluation consists of three parts:
The first part is an interview with Dr. Stanley. Dr. Stanley will ask you a range of questions about your medical history, mental health history, substance use history, and dieting and weight management history. In instances of highly complex cases, a second interview may need to be scheduled.
The second part of the evaluation entails the completion of psychological testing. These tests are designed to learn as much about a client as possible (attitudes, behaviors, emotions) in a relatively brief time. The information from the interview is then combined with the information from the tests and a report is written.
The third part of the assessment process is a follow-up meeting with Dr. Stanley. This typically occurs one week after the completion of your evaluation. During the follow-up meeting, Dr. Stanley will provide you with the results of the evaluations, including any clinical recommendations.
The assessment will help to identify your particular strengths, identify the areas you will need to address to best prepare you for surgery, and identify those areas that will optimize your success for long-term weight loss. That being the case, the recommendations for psychological clearance generally fall under four categories:
- Fully acceptable for surgery
- Conditionally acceptable for surgery
The patient evidenced reasonably well controlled mental illness and/or mild to moderate current behavioral problems. The patient will be recommended for surgery but ongoing psychological treatment will be required both before and after the surgery.
- Delayed consideration for surgery
The patient evidences poorly controlled mental illness or severe eating pathology or behavioral difficulties. Surgery will be reconsidered pending that the patient shows an improvement in these areas as a result of ongoing psychological treatment.
- Not acceptable for surgery
The patient is actively psychotic, has severe substance use difficulties, has history of multiple suicide attempts, etc.
If there are major concerns, we will discuss them with you and provide you with options for how to deal with them. Your psychologist will assist you in getting the help you need to prepare you for surgery, either by working with you directly or by making a referral to someone who is an expert in the area of concern.
Our office will send a copy of your report to your surgeon and your surgeon’s staff. Your surgeon will also know when you have scheduled the evaluation, if you kept the appointment, and when the report is completed. Your insurance company will also receive a copy of the evaluation if this is required for authorization for surgery. You will also receive a copy of this evaluation during your follow-up appointment at our office.
We are not able to release your psychological assessment until the full assessment has been paid in full (including your copay and/or deductible, insurance payment, and testing materials fee non-billable amount). If you wish to have access to your report prior to when the insurance company makes its payment, you must pay for the evaluation in full upfront. We will reimburse you for the amount the insurance company pays us. Otherwise, you must wait the 30-90 days that the insurance company takes to pay us until we can release your fully paid-for report.
While each insurance company is different, most insurance companies typically pay for most of the cost and your out of pocket expense will be the amount of the testing materials fee, as well as your co-pay, deductible, or co-insurance, if applicable. Please note that this is not a guarantee of what your insurance carrier will pay. Even within insurance companies the payment rates may be different for different policies.
Please note that some insurance plans require an authorization from your primary care office in order for the psychological evaluation services to be covered by your health insurance. If this is the case, you will be responsible for contacting your PCP’s office to receive an authorization/referral number before the first visit of your psychological evaluation.
- Is pre-bariatric surgery psychological evaluation covered under my plan?
- The diagnosis code is E66.09 and the procedure codes are 90837, 96130 and 96136. Are these procedure codes covered for that diagnosis code under my plan? Some insurance plans will not cover that combination of diagnosis codes and procedure codes, so make sure yours does.
- Will the benefit be paid by my medical plan or my mental health plan?
- Will you double check that Dr. Stanley is an in-network provider under my plan?
- Do I have to meet a deductible before my plan will pay for this evaluation?
If yes, you will have to pay on the date of your appointment. When we file your claim, the insurance company will apply that amount to your deductible.
Can I Continue to See Dr. Stanley After the Evaluation is Completed?
Yes. In some instances, additional psychotherapy services may be a requirement for recommendation for surgery. Irrespective of surgery recommendation, clients are encouraged to ask about Dr. Stanley’s behavioral health services.
Dr. Stanley is committed to helping clients live more purposeful, fulfilling, and rewarding lives. He draws upon evidence-based cognitive and behavioral principles to help clients identify and change counterproductive thoughts and behaviors. Therapy with Dr. Stanley is collaborative, solution-focused and goal oriented. He provides a comfortable, supportive, and nonjudgmental atmosphere so you can achieve the emotional and physical well-being you are striving for.