counseling, meds, etc

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Sorry for bringing up this topic again, but I obviously want to make sure I have a good handle it before acting. All the posts I see seem to be about fixing counseling and meds that have already happened.

I would like to get some counseling. Quite a few things going on in life right now. It's my understanding that counseling is reportable but not generally an issue unless a psychiatric diagnosis is made. That's all well and good but I'm wondering how you get around the diagnosis for insurance purposes issue. Paying out of pocket is not currently a option. Ideas?

And not to borrow trouble, but suppose meds are necessary. It looks like a medical is possible after being off them for a time, but I'm still confused. Would a temporary med have to be one of the approved SSRI's? If you are temporarily on them and come off, is that a SI or regular medical? Can you be off 90-120 days and keep flying until your medical expires, or do you have to go right back to the AME?

Ducks in a row, you know.
 
I will send good thoughts your way that you can work through your challenges without the medications. Yes, they can be necessary for some cases, but they can be too easy of an out versus discovering and working on the underlying problem or real cause. And possibly could mask this problem/cause making it more difficult to define and address.

Don't forget you also have the option of emailing Dr. Bruce directly if you wish to provide more detail. aeromedicaldoc@comcast.net
 
Well, to begin with, Marriage counseling is NOT reportable. See if the counseling can be couched in those terms.

If not or if the issues are wide ranging, make SURE you let the counselor know that she can code "anxiety NOS" so long as there is no recommendation for medication.

If the counselor's red light goes on and he/she is firm about chemical help, then you have two choices:

Walk out....there's no insurance record for free services.
Take the referral and see where it leads, we'll have to cleanup afterwards.....
 
Unregistered said:
Sorry for bringing up this topic again, but I obviously want to make sure I have a good handle it before acting. All the posts I see seem to be about fixing counseling and meds that have already happened.

I would like to get some counseling. Quite a few things going on in life right now. It's my understanding that counseling is reportable but not generally an issue unless a psychiatric diagnosis is made. That's all well and good but I'm wondering how you get around the diagnosis for insurance purposes issue. Paying out of pocket is not currently a option. Ideas?

And not to borrow trouble, but suppose meds are necessary. It looks like a medical is possible after being off them for a time, but I'm still confused. Would a temporary med have to be one of the approved SSRI's? If you are temporarily on them and come off, is that a SI or regular medical? Can you be off 90-120 days and keep flying until your medical expires, or do you have to go right back to the AME?

Ducks in a row, you know.
Click to expand...

We all have been through tough times. Can you find someone just to talk to? An understanding ear? Time heals all wounds. Shrinks like to mask the problems with drugs, that will likely screw things up worse. Cold turkey is not a bad thing sometimes, and you can keep flying.

What don't kill you, makes you stronger.


Jmho.
 
Wait, I thought he's not talking about a shrink. He's talking about a counselor, and a no fee service counselor, at that.....
 
bbchien said:
Wait, I thought he's not talking about a shrink. He's talking about a counselor, and a no fee service counselor, at that.....
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Well, a counselor through my EAP. Just thinking ahead for the meds, as there are other factors at play that I don't want to go into. There's some marriage counseling needed but the issues are farther than that so I don't know if someone would code it as that only.
 
bbchien said:
Wait, I thought he's not talking about a shrink. He's talking about a counselor, and a no fee service counselor, at that.....
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How would clergy fit into this sort of a situation? IIRC, some (many?) have training as counselors. Sharon B.?
 
bbchien said:
Wait, I thought he's not talking about a shrink. He's talking about a counselor, and a no fee service counselor, at that.....
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I mentioned a no fee counselor because (s)he said it would end up with a coding for insurance purposes since (s)he can't pay cash.
 
DaleB said:
In our experience, they are generally worth what you pay for them, too. Maybe we just had bad luck.
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Goes both ways, it depends where you are and where you seek help. Sometimes counties have programs where you actually see a decent shrink.
 
Henning said:
I mentioned a no fee counselor because (s)he said it would end up with a coding for insurance purposes since (s)he can't pay cash.
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The fact that the counseling is free doesn't change the reportability of it, unless you're suggesting lying on the application because you don't think the FAA can discover it.
 
Ron Levy said:
The fact that the counseling is free doesn't change the reportability of it, unless you're suggesting lying on the application because you don't think the FAA can discover it.
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How it's phrased / coded makes the difference between 'no worries' and deferral.
 
Henning said:
Because if it's free, there is no coding for insurance purposes, without a coding you can't get ****ed over for an unallowed coding.
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The regulations don't say anything about coding, only about the condition. So, I gather you believe that if you won't get caught, it's OK to lie to the FAA. As I said in the other thread today, that's the sort of hazardous attitude I've come to expect from you.
 
Ron Levy said:
The regulations don't say anything about coding, only about the condition. So, I gather you believe that if you won't get caught, it's OK to lie to the FAA. As I said in the other thread today, that's the sort of hazardous attitude I've come to expect from you.
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Yep, I'm hazardous as all hell.
 
OP here. How would I even know how it's coded if I don't pay? I'm thinking about getting a referall from my EAP. Is it on me to get the records and see how they billed my employer?
 
Unregistered said:
OP here. How would I even know how it's coded if I don't pay? I'm thinking about getting a referall from my EAP. Is it on me to get the records and see how they billed my employer?
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Yes. You're the one signing the bottom of the FAA medical application form certifying under penalty of the law that the information in the form is correct to the best of your knowledge, and without checking, you would not be able to say that (turning a blind eye is not acceptable).
 
Ron Levy said:
to the best of your knowledge
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"To the best of my knowledge" is based on the information conveyed to the patient by the practitioner, not the information that billing department sends to an insurance company. Lying about something happens when *you* intentionally deceive, not when the doctors office stretches the truth for billing purposes.

The patient's obligation is to know what the practitioner writes in their medical record and to convey that information accurately to the FAA.
 
Plausible deniability is good enough for the President of the United States, it should be good enough for the citizens. Reagan repeated "I cannot recall" something like 88 times.
 
Jeff Oslick said:
"To the best of my knowledge" is based on the information conveyed to the patient by the practitioner, not the information that billing department sends to an insurance company. Lying about something happens when *you* intentionally deceive, not when the doctors office stretches the truth for billing purposes.

The patient's obligation is to know what the practitioner writes in their medical record and to convey that information accurately to the FAA.
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Right. And the billing information provides one means to figure that out. If the billing information is different than what you submit, the FAA will assume you are the party being deceptive, not the practitioner, so make sure you know what the billing data says as well as what the practitioner tells you verbally, as one is considered documentary evidence while the other is self-serving hearsay unless the practitioner wants to admit fraud.
 
Ron Levy said:
Right. And the billing information provides one means to figure that out. If the billing information is different than what you submit, the FAA will assume you are the party being deceptive, not the practitioner, so make sure you know what the billing data says as well as what the practitioner tells you verbally, as one is considered documentary evidence while the other is self-serving hearsay unless the practitioner wants to admit fraud.
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If you don't get a bill from a free service, how would you know?
 
Henning said:
Plausible deniability is good enough for the President of the United States, it should be good enough for the citizens. Reagan repeated "I cannot recall" something like 88 times.
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It has to be plausible, and the FAA has burned people on that before. Having gone for counseling and then claiming one does not know the reason for the counseling or the diagnosis recorded isn't going to be "plausible" before the FAA.
 
Ron Levy said:
Right. And the billing information provides one means to figure that out. If the billing information is different than what you submit, the FAA will assume you are the party being deceptive, not the practitioner, so make sure you know what the billing data says as well as what the practitioner tells you verbally, as one is considered documentary evidence while the other is self-serving hearsay unless the practitioner wants to admit fraud.
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What part of:
The patient's obligation is to know what the practitioner writes in their medical record and to convey that information accurately to the FAA.
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wasn't clear to you?

I see no evidence that the OP is trying to hide anything legitimate from the record.
 
Jeff Oslick said:
What part of:

wasn't clear to you?

I see no evidence that the OP is trying to hide anything legitimate from the record.
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Not trying to hide anythingn, really. It just seems awkward to say, "so, what are you diagnosing me with?" Clearly I will if I have to though.
 
Ron Levy said:
It has to be plausible, and the FAA has burned people on that before. Having gone for counseling and then claiming one does not know the reason for the counseling or the diagnosis recorded isn't going to be "plausible" before the FAA.
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Show me a case where the pilot disclosed what they had reason to believe was the actual diagnosis, had an office code it wrong, and got hung by the FAA.
 
I can't break HIPAA. but I've seen it happen, Jeff. Believe what you want...you always seem to anyway.

"The aviation standard is higher"
"The Safety Culture of the FAA requires it".
Ever heard that?
 
Bruce,

Perhaps I wasn't clear in my post. I'm not referring to the *aeromedical consequences* of a disagreement between an insurance coding and what the airman states. I was referring to the potential for prosecution for falsification of the form based on an airmen's legitimate understanding of what a doc told them vs. what was coded on an insurance form.

Ron seems to think that pilots need to master of the nuances of insurance coding in order to prevent prosecution for "intentional falsification". I highly doubt there is case law to back that up.

Jeff
 
Unregistered said:
Not trying to hide anythingn, really. It just seems awkward to say, "so, what are you diagnosing me with?" Clearly I will if I have to though.
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Might seem awkward at first, but unless you exercise your right to know, you stand the chance of having happen to you what's happened to others who've posted their sad tales of unwittingly allowing doctors to do things which later bit them hard with the FAA.
 
Jeff Oslick said:
Bruce,

Perhaps I wasn't clear in my post. I'm not referring to the *aeromedical consequences* of a disagreement between an insurance coding and what the airman states. I was referring to the potential for prosecution for falsification of the form based on an airmen's legitimate understanding of what a doc told them vs. what was coded on an insurance form.

Ron seems to think that pilots need to master of the nuances of insurance coding in order to prevent prosecution for "intentional falsification". I highly doubt there is case law to back that up.

Jeff
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The problem is that he examiner sees the insurance code. If the counselor upcoded to get paid more (common), the airman is screwed unless the record is also in front of the examiner.

No, the guy doesn't necessarily get hung, but he gets the DEMAND letter, and a short period in which to respond. And if he's wrong, he gets denied. That's getting hung, in a way, NO?

I say, when you go for counseling, PAY CASH. That way there is no code submission at all.
 
bbchien said:
The problem is that he examiner sees the insurance code. If the counselor upcoded to get paid more (common), the airman is screwed unless the record is also in front of the examiner.

No, the guy doesn't necessarily get hung, but he gets the DEMAND letter, and a short period in which to respond. And if he's wrong, he gets denied. That's getting hung, in a way, NO?

I say, when you go for counseling, PAY CASH. That way there is no code submission at all.
Click to expand...

Now, lets see if Ron lambasts you for giving that same piece of advice.:lol:
 
I don't care how you pay -- just don't lie or conceal on the 8500-8, and part of that means making sure you know what the diagnosis was so you can enter it accurately on that form.
 
I frankly doubt that most shrinks care what the billing code is as long as they're paid. I certainly wouldn't.

OP mentioned that marital issues were part of the reason for seeking counseling, so if the shrink is amenable, I don't think it would shake the earth to its foundations if the sessions were coded as marriage counseling, or some vague and nebulous V-Code ("Partner Relational Problems," "Phase of Life Problem," "Occupational Problem," etc.) rather than a reportable diagnosis that's going to cost OP many months and thousands of dollars to sort out with OKC.

The only problem is that the EAP would be paying for it, which brings other busybodies people into the process.

It might be worth looking for a highly-trained clergy member, instead. Almost all clergy have some training in counseling, and many have a great deal of it. Depending on what, exactly, your problems are, you may find that a skilled pastor or rabbi can help you just as well as a psychiatrist or psychologist.

Best wishes to you, whatever route you choose.

-Rich
 
Payment may be code dependent, different codes paying different amounts. You go in because you're stressed about your bills and family arguments, your job sucks and you end up coded as bipolar because that allows the whomever to collect twice as much. You pay cash, you avoid the code.
 
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