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I was scheduled to have a spinal fusion. Then I got a call from my surgeon's office. Now I'm supposed to have a full-scale psych exam. Is this standard or does the doctor suspect I'm off my rocker?

Surgeons are on the hotseat (so-to-speak) these days. Insurance and third party payers are demanding proof that the intended surgery is likely to be successful. After the fact, if it's not, payment may not be made to the doctor.

Providing evidence or proof that the operation is warranted and likely to be successful is a new requirement in the quest for evidence-based medicine. If there's no evidence (or not enough evidence) that a procedure works, then patients may be denied pre-approval.

In an effort to identify patients at risk for a poor result after surgery, a biopsychosocial exam may be needed. A psychologist or psychiatrist conducts a complete exam of all potential surgical candidates before surgery can take place.

If the patient tests out at low risk, then surgery can proceed as planned. But if the patient's test scores show he or she is at high risk for failure after surgery, then a pre-surgical rehab program is advised. Patients who do well and pass this phase can be rescheduled for surgery.

Patients who remain at high (or uncertain) risk may be required to complete both a pre- and a post-surgical rehab program. In some cases, surgery may be denied if the risk appears too great.

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