What are my right s regarding treatment plans


#1

I have been on long term disability for over 2 yrs for mental health. I have been on medication trials for 2+ yrs, with no success. My psychiatrist feels that I have treatment resistant depression. My insurance sent me for an IME, who put in his report that I should try medication A, and if that doesn’t work then medication B, and if that doesn’t work medication C etc. The issue with all this is that I have a very low tolerance for medication and exhibit many side effects and the withdrawal on many of these meds are just as bad if not worse. Starting a new med is like Russian roulette as I have no idea how I will react, what the side effects will be and if these side effects can leave permanent damage. So my question is how many medication trials do I need to go on before the insurance gives a verdict of being permanently disabled? Or will I be stuck to keep trying til I get better even if that is not a likely outcome? Also, am I allowed to refuse certain medications that the IME psychiatrist put in the treatment plan if I fear the side effects too risky?


#2

Take to your treating Doctor and/or psychiatrist about the IME report and suggestions for medications. Tell them your concerns.
Follow their recommendations for treatment. If they disagree with the suggestions- then you act reasonably by not following the IME advice but following the treatment plan of your Doctors who know you.

Caution: If you do not follow the IME advice for meds, even if your Doctors advise against it-the Insurance Company may find this unreasonable and terminate your income benefits.

If the IME was a psychiatrist then you should review with your Psychiatrist as well as your Doctor.

But it is reasonable to rely on your Doctors advice -you just have to be prepared to potentially sue.

Without Doctor support in refusing a trial of medication-you should try or will be very likely cut-off.

Wish it was an easier choice. Since they are paying money to assess your claim-you may need the advice of a lawyer.


#3

You can always refuse treatment. You need medical support giving reasons why the medication is too risky or inappropriate to stay on claim-or to have a successful legal claim,

My husband is on morphine sanctioned by the pain clinic. His anesthesiologist from the pain clinic gave him a hand written note showing all the medications he has tried and failed or has resulted in severe suicidal depression. He takes a copy to all new Doctors for their file. This stops him from having to hear about the dangers of opioids.

Perhaps you could have a Doctor do the same with respect to your meds.


#4

Thanks for the response. So basically, unless I take them to court, I will always have to continue taking all sorts of meds :frowning: Not great options. I was hoping there would be a time limit on how many treatment plans they can enforce on me.


#5

If your Doctor/Psych agrees with trying the medications you are on shaky ground to refuse. Its up to your treatment providers if they agree. Certainly let them know what your fears are.

If you try a few times and it makes you worse-then you have proof to stop all the medication change ups.
You are not powerless-you just need a medical reason for why the medications are too risky or not sanctioned by your Doctor.

If you have to try new meds get the pharmacy list on side effects to include in your medical records. If they make you ill or regress then see your Doctor more regularly and tell/document.

Just be happy they are not sending you for the PGAP or counselling/exercise programs run by their peeps.
You are in control-Hang in there


#6

I have a great doctor that has my back, I’m just tired and I don’t want to give them any reason to cut me off. Thanks again for answering :slight_smile:


#7

Out of curiosity -Was the IME fair to you?


#8

He said quite a few things that I disagree with and wrote many misleading comments in his report. His visit/report was very upsetting and I’d never been treated that way by any of my doctors. I guess his assessment of me could have been more unfair, but he didn’t have that much leeway considering I am so well followed and documented by other professionals that he would have to say they were completely incompetent if he were to pretend I was well. Needless to say his treatment plan is quite questionable and shows where his loyalties lie.


#9

Thanks for sharing. My husband went through a psychological assessment for treatment with a Doctor/Psychologist through an Insurer referral. It was suppose to be for up to 10 sessions. First session he finds out that he has to have psychological testing as well as an interview. My husband asked if this was all legit and if he was his patient. The Psych said he was his patient, after some back and forth said if he did the psych testing he would give him the report.
The whole interview the Psych was looking at him with a skeptical look. Like being interrogated by opposing counsel.

Next visit-Psych was not sure if he was his patient-but had a draft report for us to read. He no longer was giving us his report. I asked if I could have a copy of the draft report-he said no because it is just a draft-its not even the report I am sending!
So I took out my iphone and recorded myself reading the draft report into the phone.

It ended up being the report that was sent.

My husband agreed to the psych testing on condition of getting a copy of the report-we were so set up.
And the real kicker is my husband was not on disability for a psychological claim


#10

Sounds funny :grinning:


#11

If you would be unable to work even though the psychiatric condition was treated with these new pharma suggestions, then the insurer should not deny you benefits either.


#12

Who knows if that would deter them or not. Would they expect me to keep trying new meds for the rest of my life or would it just be accepted for what it is; treatment resistant?


#13

No, that would be unreasonable. They will also likely back off if you tried a new med and ended up worse off :slightly_smiling_face:


#14

Sorry for not responding to your earlier post…My own doctor gave me a copy of the IMEvaluator’s report as the IMEvaluator made me sign papers that I would not be getting a copy from him and that I should not record the session. As far as I knew, IME was a one time thing. 10 sessions seems like a crazy amount for someone who is not your doctor.


#15

It was suppose to be his treatment provider under a GWL recommended rehab plan. My husband was set up to fail or be harassed off claim. The Psych knew how important getting a copy of the report was to us, so sucker punched my husband into taking psych tests-then changed his mind next appt, on allowing him a copy of the report, The psych knew that would set us off. What he did not expect is that we recorded everything.


#16

It’s all about discouraging us to continue. Is everything settled with your husband now? Did he win his case?


#17

He has just started the lawsuit. Have not got their defense yet. Right now they are paying him half of his benefits.
He wants accountability for their mishandling of his claim-its not a big claim. GWL has given him a rough time and it will be therapy for him to have his day in court.


#18

I hope it works well for you guys. This whole business is so stressful.