Any reason not to use insurance?

[Anon]

Hi all,

Yet another mental health thread with a small bit of a twist.

For the past few years I have been having some rough times between some things going on within my family, my partner, and a lot of issues with work. About 2 years ago I sought talk therapy for some issues, immediately self-grounded and have not flown since, paid with insurance, and got a dx of adjustment disorder w/ anxiety. I was in therapy for about 3-4 months, got past some milestones at work and resolved some stuff within my personal life. No medication ever prescribed nor a visit to a psychiatrist.

Fast forward to about 5 months ago and I was really struggling with issues at work. I finally decided I needed help once again and sought out another therapist. I had always known that the FAA is terrible on mental health issues, but after my first round of therapy I did a lot of searching (here and elsewhere) and discovered just how onerous they were. I decided to pay out of pocket for this therapist and have been paying for it out of pocket ever since. I got another adjustment disorder dx (without anxiety as far as I know) but have already decided I will declare this as needed moving forward. I do not want to fly if I cannot do so legally, ethically, and responsibly. My question therefore is there any reason to keep paying out of pocket? My insurance will cover the therapy, I can afford to keep paying out of pocket and have done so out of some sense of security of it, but if there is no reason to do so I might as well save the money. Again thusfar no psychiatry visits or medication, although I am considering it.

For background, I held a standard (no SIs) 3rd class medical until about a year or so ago when it lapsed (don't remember exactly when because I hadn't been flying for a year or more anyway). I am considering moving to basic med in the future, but am not really sure if I would need a one time SI.

A lot of my issues stem around my work, specifically I am finishing a PhD program and have been struggling with the final phases a lot (please don't give me the "if you can't handle a PhD you shouldn't be a pilot" lines, I have been a safe pilot for more than a decade). I am hoping once I am done I can return to a place of mental balance wherein I can fly again, but I have accepted that there is the possibility this will be a lifelong struggle that will prevent me from flying again. I will not know which is the case until I am done. I am just trying to balance finishing my work for a few more months and not degrading further with not screwing over my flying life for the rest of my life unnecessarily.

Any constructive advice at all welcome.

 

[KeepWatch]

The latter phases of grad school are tough. Been there, done that. Writing got to feel like pushing a chain 8 miles uphill. Find some good friends in similar situations and get everything (EVERYTHING) out in the open. It helps.

I'll let others comment on the rest of what you're asking.

 

[Anon (OP)]

The latter phases of grad school are tough. Been there, done that. Writing got to feel like pushing a chain 8 miles uphill. Find some good friends in similar situations and get everything (EVERYTHING) out in the open. It helps.

I'll let others comment on the rest of what you're asking.

Thanks for the words of encouragement. Yeah writing has been very difficult, not to mention large bouts of imposter syndrome and a lot of pressure and high standards, mostly self-imposed. I have a good friend group and support system, but I agree it was much better when I came out of hiding about it. Honestly a big portion of the avoidance in seeking help was fear of never being able to fly again. I know it should always be health first, flying later, but when flying is a life's passion and goal, it is easier said than done. It took getting to a pretty bad place to force me to re-evaluate and get help. To me it really underscored how detrimental the FAA's draconian view of mental health issues are. I can't imagine how hard it is for actual commercial pilots whose entirely livelihood depends on a medical.

 

[Half Fast]

...but have already decided I will declare this as needed moving forward. I do not want to fly if I cannot do so legally, ethically, and responsibly.

Good for you.

As far as I can see, the only reason not to use insurance would be if you were trying to hide a diagnosis from the FAA. Since you've already decided against that, why not use your insurance?

 

[Anon (OP)]

Good for you.

As far as I can see, the only reason not to use insurance would be if you were trying to hide a diagnosis from the FAA. Since you've already decided against that, why not use your insurance?

That was my thinking but I wanted to ask around before I took the plunge and did the un-reversible. I feel like half the battle with the medical process is never really knowing how many gotchas are in store for you and how bad your situation really is. Looking at all the various posts I came away with a sense of "these two cases on their face seem pretty similar but the process the individuals went through is wildly different".

 

[flyingron]

Get well first, then worry about your medical. If you went to a practitioner, the record is out there whether you pay him with cash under the table or you use insurance. They're protected by the same level of confidentiality, which essentially you waived by getting your medical, but in practice, the FAA doesn't largely go behind your back to insurers or providers for the information. If something has alerted them to you, they'll demand you release the records to them or they'll deny you.

 

[X3 Skier]

I did everything except the Dissertation for My Doctorate in Engineering. I planned to do the research at my job but got more interested in the “real world” aspects of aircraft development and never finished. I supposed it would have been nice to be Dr A but work was more fun.

If the Ph D is getting in the way of a happy and less stressful life, pull the handles and eject form the program. I did and never looked back.

Cheers

 

[Lindberg]

If you go to basic med, these are the mental health conditions that would require you to get a one-time SI:

(i) Personality disorder severe enough to have repeatedly manifested itself by overt acts
(ii) Psychosis
(iii) Bipolar disorder
(iv) Substance dependence within the previous 2 years

And this only applies if the condition newly developed since your medical expired. It doesn't sound like any fit. So just get this behind you and then go basic med.

 

[bbchien]

I would add that there is great difficulty @FAA even with its HIMS psychiatrists when there are two episodes of "adjustment". Then it becomes a recurrent disorder (anxiety disorder, recurrent). The DSM 5 only gives adjustment disorder two years' duration.

I was long ago in a PhD program and took my qualifying exams- but that was the year (Dec 1982) that I got the letter from Dr. Anthony Fauci (my indirect boss, yes the same one) that I had to reapply for year 2 of my six year RCDA grant (RO-1) as Sen Kennedy had put NIH on zero line budget. Then I got the second letter that cut funding 20% because Sen Kennedy had cut the NIH budget 20%.

That was stressful (and not worth it to me) and I walked out, back into clinical medicine.

So I get that PhD level grad school is ONE HUGE STRESSOR.....get well, survive and we need to find you a good consultant. It think you will succeed as you have not been Medicated either time.....

 

[steingar]

If grad school causes this level of anxiety bail right now. It only gets worse. Way worse, at least in my end of the biz. If you can’t take the heat you don’t belong in the kitchen. Get your doctorate and do something else.

 

[Eric Brunelle]

I did everything except the Dissertation for My Doctorate in Engineering. I planned to do the research at my job but got more interested in the “real world” aspects of aircraft development and never finished. I supposed it would have been nice to be Dr A but work was more fun.

If the Ph D is getting in the way of a happy and less stressful life, pull the handles and eject form the program. I did and never looked back.

Cheers

A real PhD is an awesome accomplishment - not something I have the confidence that I could do. I work with two phonies who got "PhD's" - one from Canterbury University, and one from Charter University. They get no respect, but refer to themselves as docs.

 

[Eric Brunelle]

A real PhD is an awesome accomplishment - not something I have the confidence that I could do. I work with two phonies who got "PhD's" - one from Canterbury University, and one from Charter University. They get no respect, but refer to themselves as docs.

...and please don't think I am commenting on you. With the amount of stress you are going through, and being a highly motivated pilot-type, I am sure yours is the real deal.

 

[Anon (OP)]

If you go to basic med, these are the mental health conditions that would require you to get a one-time SI:

(i) Personality disorder severe enough to have repeatedly manifested itself by overt acts
(ii) Psychosis
(iii) Bipolar disorder
(iv) Substance dependence within the previous 2 years

And this only applies if the condition newly developed since your medical expired. It doesn't sound like any fit. So just get this behind you and then go basic med.

Yeah that's what I thought but

a) The first condition is really generic ("what counts as overt acts?") and I am not 100% sure what is medically considered a personality disorder. As someone in a technical field, I am well aware how seemingly simple sounding words can have very specific meanings that are lost on lay people. I don't know the DSM-V at all and don't pretend to, so I am not sure if things like Adjustment disorders count as personality disorders within that technical framework

b) On this forum and elsewhere there seems to be strong disagreement between individuals (the threads I am referring to and the individuals involved are not hard to find) as to when a one-time SI is needed or not. Furthermore there doesn't even seem to be a consensus on *how* to figure out if a one-time SI is needed or not..

 

[Anon (OP)]

I would add that there is great difficulty @FAA even with its HIMS psychiatrists when there are two episodes of "adjustment". Then it becomes a recurrent disorder (anxiety disorder, recurrent). The DSM 5 only gives adjustment disorder two years' duration.

So I get that PhD level grad school is ONE HUGE STRESSOR.....get well, survive and we need to find you a good consultant. It think you will succeed as you have not been Medicated either time.....

Thank you for weighing in!

Yeah the fear of a second diagnosis and getting slapped with the "recurrent" label prevented me from seeing a counselor again for quite some time. Honestly in my mind it has all been one continuous progression of issues (not only related to work, there have been other major stressors as well. Needless to say the past few years have been pretty tough ones) but for a while I got to the point where I felt well enough to continue without talk therapy and did so for two years.

I know this is a sticky question, but for me basic med could suffice. At one point I had hoped to get a commercial license and/or possibly instruct, but at this point I am just hoping I can fly beyond sport pilot (instrument rated and very much enjoy IFR work). Can you weigh in on going basic med? As I said in another post, I recognize that there doesn't always seem to be a definitive answer to this question... I want to do things properly and legally, but I am finding it very difficult to determine what that even means viz a vis basic med vs third class medical. If I go to a HIMS AME for a consult does that automatically force me into going down the third class medical route? Could a HIMS AME even tell me whether I am eligible for basic med without an SI?

 

[Anon (OP)]

I did everything except the Dissertation for My Doctorate in Engineering. I planned to do the research at my job but got more interested in the “real world” aspects of aircraft development and never finished. I supposed it would have been nice to be Dr A but work was more fun.

If the Ph D is getting in the way of a happy and less stressful life, pull the handles and eject form the program. I did and never looked back.

Cheers

Call it sunken cost fallacy but I have finished the research (been doing that for the past 4.5 years + 2 years for my masters) and have about 60% of a rough draft of my dissertation at this point, so I really don't want to quit now and don't think I would ever forgive myself if I did. Don't think I didn't about quitting throughout the years though, but somehow I pushed myself along...

 

[Anon (OP)]

If grad school causes this level of anxiety bail right now. It only gets worse. Way worse, at least in my end of the biz. If you can’t take the heat you don’t belong in the kitchen. Get your doctorate and do something else.

I am not quite sure what you're suggesting, but my intention wasn't and isn't to go into academia anyway. I enjoy research generally and hope to do so in some form of an industrial setting. I also might just do the standard thing and pivot to tech. I have worked in tech some before and enjoyed it so long as it isn't at a company whose entire purpose is to make it easier to sell ads or some nonsense.

 

[Anon (OP)]

...and please don't think I am commenting on you. With the amount of stress you are going through, and being a highly motivated pilot-type, I am sure yours is the real deal.

No worries I don't think you are. While I can only see the flaws in my work and think it is entirely insufficient (I think near the end this is true for every PhD candidate) I can recognize that by most objective definitions my work is "the real deal."

 

[GaryM]

If grad school causes this level of anxiety bail right now. It only gets worse. Way worse, at least in my end of the biz. If you can’t take the heat you don’t belong in the kitchen. Get your doctorate and do something else.

It doesn't always get worse. Finishing and defending a thesis is tough, been there, done that. If you can push through and finish, I think you'll be glad you did, but only you can judge if the current stress is something you can deal with.

I've certainly had times in my professional career where my stress level was higher than when I was in grad school, but there have also been many times where things were less stressful. It depends on your current job, and to a large extent, your current boss. But those factors will change, and often.

 

[Lindberg]

Yeah that's what I thought but

a) The first condition is really generic ("what counts as overt acts?") and I am not 100% sure what is medically considered a personality disorder. As someone in a technical field, I am well aware how seemingly simple sounding words can have very specific meanings that are lost on lay people. I don't know the DSM-V at all and don't pretend to, so I am not sure if things like Adjustment disorders count as personality disorders within that technical framework.

Google doesn't think that adjustment disorder is a personality disorder, but the simple answer is to ask your doctor. Unless you're trying to talk yourself out of flying, which is ok. If you hang around here, someone will definitely try to convince you that you shouldn't do it. Even without basic med, you can still fly sport or gliders, as long as you don't currently have a condition that would make flying unsafe.

 

[Half Fast]

Basic Med is essentially informed self-certification. The required physical (every 4 years) and training course (every 2 years) provide you with the information you need to make an informed decision. Your doctor is supposed to discuss with you his exam findings and the medications you're taking. Note that there is no "pass/fail" criteria on the exam checklist; it's just a list of things he's required to examine. If he signs off the exam and you complete the course, and if your personal assessment is that you're fit, you're able to fly legally.

Don't overthink it, but use good judgement.

 

[Anon (OP)]

Basic Med is essentially informed self-certification. The required physical (every 4 years) and training course (every 2 years) provide you with the information you need to make an informed decision. Your doctor is supposed to discuss with you his exam findings and the medications you're taking. Note that there is no "pass/fail" criteria on the exam checklist; it's just a list of things he's required to examine. If he signs off the exam and you complete the course, and if your personal assessment is that you're fit, you're able to fly legally.

Don't overthink it, but use good judgement.

Great thanks, to you and all the other posters who provided useful information. I think in all likelihood I will go to basic med when the time comes if that avenue works out. First thing will be to finish, then get healthy, and finally go up with a CFI to see if it is something I still can safely pursue.

 

[flyingron]

It's actually not self-certification [SIC]. First off, people misuse the term "self certification" all over the place. It hasn't existed in decades. The term came from a time when glider pilots (who didn't otherwise hold a medical) actually had to make a certification that they were medically compliant with the regulations. That obligation hasn't been around in a long time. They just are exempt from any medical certification. All pilots are obliged to "self assess" their ability to fly on each flight.

Basic med just reinforces the need for that self assessment in the pilot education part. But it's still a physician who makes the overall determination at least once every four years.

 

[Half Fast]

But it's still a physician who makes the overall determination at least once every four years.

Yes, sort of, but you can't fail BM like you can class 3. The physician has no pass/fail criteria he must apply, and if he won't sign you can go fly Sport Pilot rules or find another doc. Most discretion is left with the pilot.