Loss of medical/certificates due to past events

[Blookite]

Hi all, this is my first post. I know there are a lot of posts relatively similar to mine but not exactly. Right after Thanksgiving i had a devastating realization that will probably end my career. I've already spoken with Dr. Chien and he has very clearly laid out the steps i need to take. I've just been feeling incredibly isolated and want to get some more opinions and experiences about things before i decide if i want to hassle Dr. Chien more or seriously pursue evaluations.


I was preparing for my commercial checkride with plans to go to the airlines. I was applying for my third 1st-class medical when i came to i believe question 18 on the 8500-8 Medexpress form. After looking at my medical history, i noticed some active "problems" that i was diagnosed with in 2011 as a high schooler. This included anxiety-induced IBS and social anxiety disorder. I had forgotten completely about these things and i couldn't recall if i even put them on my prior two applications, which is bad. I dug deeper than i ever have to see what other dirt i can find on myself. To make a long story short, in 2007, at the age of 13, i was diagnosed by a counselor with having "adjustment disorder with depressed mood" and the notes of these visits state multiple times that i had "suicidal ideation", that police were called on me by my parents because of my anger, and all sorts of nasty things. Both my parents who were the ones who reported these things to the behavioral health counselor in 2007 were appalled that those things remained in my permanent medical record, at the time they had no idea these things would forever stain my record and the way they were recorded are pretty exaggerated. My relationship with my parents was 99% very good and we have always been on excellent terms, it was just 1% of me having a few bad days due to bullying in school, divorce, and other things (all recorded in the notes). Now my parents are very upset that they said anything because these notes do not portray an accurate image of our family at all. Nevertheless, my medical records say i had suicidal ideations and police called on me in the notes.


My only actual diagnosis from those visits was "adjustment disorder". I was never actually diagnosed with depression, being suicidal, i was never hospitalized for being suicidal. It's only from either myself or my parents saying it, so it was jotted down in the notes section. It has been 14 years since my incidents but those 14 years have not been evaluated by a professional. The behavioral health expert who wrote those notes recommended, "Get better sleep and eat more", then never followed up with me again. I was placed on Prozac for about 6 months and stopped taking it on my own. Then my doctor visits went back to just normal physicals.


I've self-grounded myself indefinitely. My first step was trying to get a hold of my past Medexpress records to see what information i may have inadvertently omitted. After sending them release forms, i have yet to receive anything from them after two months.


Some of the items i will be facing are HIMS Neurological evaluation, HIMS Neuropsychiatric evaluation, MRI of my brain, and other items. This will be prohibitively expensive as i don't believe my health insurance would cover this due to being a regulatory issue.


I have been obsessed with aviation since i was four years old and it's a really bitter sting to make it all the way to commercial level and then lose it all. I'm expecting an emergency revocation of all my certs / ratings, which would add to the time and cost, making it twice as devastating, and more so to my parents who have invested everything to get me this far into this career. I can never repay them in my whole life.


I'm curious if anybody who has gone through the HIMS process has had insurance cover any portion of it?

 

[flyingron]

"Counselors" have no business making psychiatric diagnoses. This should be left to trained doctors. I'm sorry amateurs have given you black marks on your history.

HIMS and almost everything involved with airman certification is usually viewed upon as "occupational" by insurance companies and they will not cover it. There might be some testing or visits that might be coverable under your general mental health stuff and if the FAA wants something on IBS issues, you might be able to get that covered, but really you should budget that this will be 100% out of pocket.

 

[PaulS]

Dr. Chien told you what to do. If you want to fix it, stop farting around and get it done. All this other worrying and hand wringing is useless crap. Hire Dr. Chien, do what's required, get it done. Using insurance for stuff like this usually requires a reason, like "patient said he was depressed". Not good for the faa imo. You've got a road map from a pro, use it. HTFU.

You are about to get a bunch of post about how the faa sucks, and lawyer up and whatever. Just do what you've been told by Dr. C and get it done. Quit whining.

 

[brcase]

Dr. Chien told you what to do. If you want to fix it, stop farting around and get it done. All this other worrying and hand wringing is useless crap. Hire Dr. Chien, do what's required, get it done. Using insurance for stuff like this usually requires a reason, like "patient said he was depressed". Not good for the faa imo. You've got a road map from a pro, use it. HTFU.

You are about to get a bunch of post about how the faa sucks, and lawyer up and whatever. Just do what you've been told by Dr. C and get it done. Quit whining.

Dr Chien will give it to you straight. Based on what he has told you is possible/reasonable to do. You decide if and how you want to proceed. Then do exactly what he says you should do, exactly like he tells you to do it, nothing more, nothing less.

Brian
CFIIG/ASEL

 

[Skip Miller]

I am also alarmed to hear that you even remotely considering “hassling” Dr. Chien in this matter. He is THE acknowledged expert in difficult medicals. ****ing off Doctor Bruce is not a good strategy. He is on your side. My advice parallels that of PaulS, post #2 above.

-Skip

 

[DaleB]

I am also alarmed to hear that you even remotely considering “hassling” Dr. Chien in this matter. He is THE acknowledged expert in difficult medicals. ****ing off Doctor Bruce is not a good strategy. He is on your side. My advice parallels that of PaulS, post #2 above.

-Skip

I interpreted his "hassle Dr. Chien" bit was wondering whether he should even proceed or not. It's got to be a gut-punch and right now he's probably wondering whether it's even practical to proceed.

@Blookite, only you can make that call. Give it a few days to sink in so you're not making decisions based solely on raw emotion. If you haven't already done so, figure out a realistic expectation about the time and expense involved. Figure out whether you can do it, what it's going to take to do it, then whether or not you still want to do it. It may mean finding another short term career to fund the path to certification.

 

[Mason]

Do what Doc Bruce says. He's the expert at this.

 

[Charlie Golf]

I am also alarmed to hear that you even remotely considering “hassling” Dr. Chien in this matter. He is THE acknowledged expert in difficult medicals. ****ing off Doctor Bruce is not a good strategy. He is on your side. My advice parallels that of PaulS, post #2 above.

-Skip

I'm willing to bet that "hassling" referred to not wanting to bother Dr. Bruce/waste his time.

I don't think it was meant in a negative sense.

 

[123]

Thanks for all replies. Yes, Dr. Bruce has given me a clear path which i trust is the best path to pursue. I've been sitting on this for about two months now. My current situation is that this path is impossible to pursue due to costs. I break perfectly even after receiving my paychecks and then paying rent. I see some pilots paying up to $17,000 in the HIMS program, then paying annually for follow-ups, or sometimes still being denied, and spending $17,000 to be denied would be catastrophic. It's literally a blind gamble.

Me pursuing this definitely would hinge upon receiving help from insurance. I'll inquire about it to them, it's worth a shot.

 

[Dana]

Insurance won't cover it.

Short term, don't apply for another medical now, let your current medical expire, fly on basicmed or sport pilot and build hours until you can afford to deal with the medical. You can't take the commercial checkride or fly as a job until you get it resolved, but you'll be flying.

 

[JOhnH]

Do what Doc Bruce says. He's the expert at this.

I don't think he was questioning Dr. Chien.
I think he was only questioning whether he had the desire to jump through all the hoops and expenses that Dr. Chien told him he would.

That is a question that only he can answer, but posting it on this board seems to be his attempt to help think this through and maybe get a feel for what others have gone through.

I don't understand why some of you want to make him the bad guy here, or why you think he should do what Dr. Chien told him to do if he decides it isn't worth it to him.

 

[DaleB]

Short term, don't apply for another medical now, let your current medical expire, fly on basicmed or sport pilot and build hours until you can afford to deal with the medical. You can't take the commercial checkride or fly as a job until you get it resolved, but you'll be flying.

Assuming he doesn't get his medical pulled... then he's screwed, other than gliders of hot air balloons.

 

[Daleandee]

Assuming he doesn't get his medical pulled... then he's screwed, other than gliders or hot air balloons.

He would still have part 103 i.e. ultralights. They are fun enough but a true "legal" 103 machine is pretty hard to find and they are fair weather machines.

 

[DaleB]

He would still have part 103 i.e. ultralights. They are fun enough but a true "legal" 103 machine is pretty hard to find and they are fair weather machines.

Sigh. I knew that was coming. Yes, there's always ultralights. I didn't specifically mention them for much the same reason I don't usually even mention gliders and hot air balloons... they won't meet the needs or desired of 99% of pilots. The exception would be a "self launch" glider, but even that won't get him anywhere near a flying career.

 

[Daleandee]

Sigh. I knew that was coming. Yes, there's always ultralights. I didn't specifically mention them for much the same reason I don't usually even mention gliders and hot air balloons... they won't meet the needs or desired of 99% of pilots. The exception would be a "self launch" glider, but even that won't get him anywhere near a flying career.

Not trying to cause you any grief just making sure the OP knows all of his options.

BTW ... if you knew it was coming why didn't you avoid it?

 

[wardor]

Dr Chien helped me with my issues

 

[Half Fast]

My current situation is that this path is impossible to pursue due to costs. I break perfectly even after receiving my paychecks and then paying rent.

Find a cheaper place to live, or get a second job, or start living on rice and beans. How important is flying as a career to you, and what sacrifices are you willing to make?

I’m not trying to be cruel and I do have sympathy for you. But most money problems can be solved somehow by a person who is determined and doesn’t let the problem frighten him.

How much determination will you show in a life-threatening flight situation? Use that same sort of determination now, find a solution and work through your problem.

 

[ThatOtherGuy]

I'm curious if anybody who has gone through the HIMS process has had insurance cover any portion of it?

Directly answering your question.....

Medical insurance will only cover procedures which are deemed "medically necessary". This means the procedure is either treating a known condition or diagnosing an unknown condition. In your case you have numerous conditions listed in your medical record that were diagnosed by medical professionals. I'm not saying they're all correct, just that they're in the record. The most likely reasons they're in the record is because the diagnosis was accurate or because the treating professional needed to code it under something in order to get paid.

HIMS and the associated medical visits are forensic in nature. That means they're not treating any condition. They're evaluating someone against standards to make a determination as to whether that person meets the standards with regards to known conditions. During some of these evaluations you're paying for them, but the FAA is actually the customer. You would have limited rights to the results of those evaluations.

Short version, your insurance agreed to cover medically necessary conditions. They didn't agree to pay for any medical services in which you choose to partake. There's nothing medically necessary about holding an FAA medical. You're going to have to pay out of pocket if you decide to proceed down the HIMS path.

 

[AggieMike88]

Insurance won't cover it.

Short term, don't apply for another medical now, let your current medical expire, fly on basicmed or sport pilot and build hours until you can afford to deal with the medical. You can't take the commercial checkride or fly as a job until you get it resolved, but you'll be flying.

Dana has a good plan here. No matter what, you need to keep adding time to the logbook.

You likely qualify for BasicMed, so do that, fly frequently, and continue adding hours to the book.

Also look for additional employment. Start a new account at your bank labeled “do what Doc Bruce said to do” and every bit of income from new job(s) goes there. Once there is enough to complete a step, complete that step. Rinse. Repeat.

With discipline and perseverance, you can do this.

 

[Blookite1]

I've been writing from work a bit hastily but some items i forgot to mention are i obtained my private well within the 10-year period after the suicide ideations were documented, soloed with a first-class medical 6ish years after. As of now those incidents were 14 years ago. So the FAA may interpret my certificate as ill-received and revoke it as well as my instrument rating.

i'm curious, if the FAA demands my certificate, when i make my appeal, would it be a possible outcome that i can request to keep my certificate but surrender my medical (obviously)? Since my certificate is worthless without the medical anyway. But this would prevent me having to start completely over again with check rides after i regain my medical.

I've thought of a potential way out. The HIMS process would be detrimental to me financially. However, prior to this, i was going to apply for the Horizons Pilot Development Program which offers a $12,500 stipend. If upon completing the HIMS evaluations i can be found fit to fly again, that stipend could help me recover fully.

 

[Lindberg]

I've been writing from work a bit hastily but some items i forgot to mention are i obtained my private well within the 10-year period after the suicide ideations were documented, soloed with a first-class medical 6ish years after. As of now those incidents were 14 years ago. So the FAA may interpret my certificate as ill-received and revoke it as well as my instrument rating.

i'm curious, if the FAA demands my certificate, when i make my appeal, would it be a possible outcome that i can request to keep my certificate but surrender my medical (obviously)? Since my certificate is worthless without the medical anyway. But this would prevent me having to start completely over again with check rides after i regain my medical.

I've thought of a potential way out. The HIMS process would be detrimental to me financially. However, prior to this, i was going to apply for the Horizons Pilot Development Program which offers a $12,500 stipend. If upon completing the HIMS evaluations i can be found fit to fly again, that stipend could help me recover fully.

If you reapply for a medical while your current medical is valid and disclose all the stuff you were previously unaware of, as you now must, there is a good chance the FAA will revoke your current medical. Even if they don't, you'll be defered/denied on your new application. You will be dead in the water even if they don't come for your pilot certificate because they think you deliberately withheld information.

Your only choices at that point will be 1) fly gliders/balloons/ultralight or 2) spend much $$ and time trying to convince the FAA you are worthy.

On the other hand, reread Dana's advice.

 

[PaulS]

How do you know what HIMS will cost?

 

[Lachlan]

How do you know what HIMS will cost?

Doc Chien probably advised him on the initial consult.

 

[PaulS]

Doc Chien probably advised him on the initial consult.

Maybe, but it doesn't seem like it. He has some obstacles, but addiction doesn't seem like one, from what I've seen here that looks most expensive. Ideally he would do the series dr. C said, things would be good and he gets issued. If things come back complicated then he needs to rethink.

My point is he really has no idea until he sits down for a hims psychologist consult where that doc gives him an estimate. I would get that done, otherwise asking here is just guessing.

 

[BladeSlap]

Directly answering your question.....

Medical insurance will only cover procedures which are deemed "medically necessary". This means the procedure is either treating a known condition or diagnosing an unknown condition. In your case you have numerous conditions listed in your medical record that were diagnosed by medical professionals. I'm not saying they're all correct, just that they're in the record. The most likely reasons they're in the record is because the diagnosis was accurate or because the treating professional needed to code it under something in order to get paid.

HIMS and the associated medical visits are forensic in nature. That means they're not treating any condition. They're evaluating someone against standards to make a determination as to whether that person meets the standards with regards to known conditions. During some of these evaluations you're paying for them, but the FAA is actually the customer. You would have limited rights to the results of those evaluations.

Short version, your insurance agreed to cover medically necessary conditions. They didn't agree to pay for any medical services in which you choose to partake. There's nothing medically necessary about holding an FAA medical. You're going to have to pay out of pocket if you decide to proceed down the HIMS path.

I wouldn’t say “forensic” that involves real science and evidence based medicine, the correct word is “administrative” in nature.

 

[WDD]

You can get a Commercial and CFI on Basic Med.

You can’t get paid for flying commercial - but you can get hours and get paid for flight training.

But - only you can decide if you want to pay the $ and roll the dice to get a Class 1.

if you apply and goes into denial I think that terminates your Basic Med.

 

[BladeSlap]

What about moving abroad to somewhere you can get a medical?

Maybe get all the certs on basic or something and then move somewhere you can get a medical?

 

[mryan75]

You likely qualify for BasicMed, so do that, fly frequently,

How would someone with a disqualifying psych condition who may have (even inadvertently) not reported what are likely multiple disqualifying conditions on previous medical applications qualify for BasicMed?

 

[WDD]

How would someone with a disqualifying psych condition who may have (even inadvertently) not reported what are likely multiple disqualifying conditions on previous medical applications qualify for BasicMed?

Basic med disqualifying conditions don’t seem to apply to the OP

• A personality disorder that is severe enough to have repeatedly manifested itself by overt acts;
• A psychosis, defined as a case in which an individual —
  • Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or
  • May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;
• A bipolar disorder; or
• A substance dependence within the previous 2 years, as defined in §67.307(a)(4) of 14 Code of Federal Regulations

 

[BladeSlap]

“grossly bizarre or disorganized behavior”

Sounds like a 91.13 type phrase

Plus psychology is more or less about as scientific as chiropractics

 

[WDD]

“grossly bizarre or disorganized behavior”

Sounds like a 91.13 type phrase

Plus psychology is more or less about as scientific as chiropractics

Chiropractic - that’s funny

But for the OP - I don’t think that is a psychosis. In any event what I think doesn’t matter. It’s the medial opinion of the OP’s doctor that does. FAA doesn’t review Basic Med, so they can’t review if Basic Med requirements are met- catch 22?

Should or should this not be allowed? I don’t know - don’t offer an opinion. Just commenting on what I think the rules allow.

 

[SkyChaser]

Chiropractic - that’s funny

But for the OP - I don’t think that is a psychosis. In any event what I think doesn’t matter. It’s the medial opinion of the OP’s doctor that does. FAA doesn’t review Basic Med, so they can’t review if Basic Med requirements are met- catch 22?

Should or should this not be allowed? I don’t know - don’t offer an opinion. Just commenting on what the rules allow.

I think the idea is, the doctor who signs that person off for Basic Med is going to care, because it's their signature and license in the fray after a pilot who shouldn't be flying crashes, so the FAA doesn't have to review it.

To the OP, I'd "hassle" Dr. Chien about it if you'd like to fly. I don't know for sure if stuff in notes matters, but he would know.

 

[mryan75]

Basic med disqualifying conditions don’t seem to apply to the OP

• A personality disorder that is severe enough to have repeatedly manifested itself by overt acts;
• A psychosis, defined as a case in which an individual —
  • Has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis; or
  • May reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of psychosis;
• A bipolar disorder; or
• A substance dependence within the previous 2 years, as defined in §67.307(a)(4) of 14 Code of Federal Regulations

Multiple indications of “suicidal ideations” and “other nasty things” would presumably be disqualifying of the medical he currently holds. I would strongly question his eligibility for BasicMed.

 

[Half Fast]

Multiple indications of “suicidal ideations” and “other nasty things” would presumably be disqualifying of the medical he currently holds. I would strongly question his eligibility for BasicMed.

But he's under no obligation AFAIK to report those until his next renewal. Granted his renewal would likely be denied, but rather than renewing, he could just let the medical expire. Once a medical has expired the FAA cannot revoke it and he would remain eligible for Basic Med unless "suicidal ideations" is considered evidence of psychosis. Is it?

Not saying this is wise, but I believe it's how the system works.

 

[mryan75]

But he's under no obligation AFAIK to report those until his next renewal. Granted his renewal would likely be denied, but rather than renewing, he could just let the medical expire. Once a medical has expired the FAA cannot revoke it and he would remain eligible for Basic Med unless "suicidal ideations" is considered evidence of psychosis. Is it?

Not saying this is wise, but I believe it's how the system works.

To me the point is that he never qualified for the medical he actually got. Suicidal ideation are indeed disqualifying. And we don’t even know what the other “nasty stuff” is. I always presume we get at most half the story in these posts. But from just what the OP says here I don’t believe they ever qualified for a medical and thus wouldn’t be eligible for basic med.

 

[Half Fast]

To me the point is that he never qualified for the medical he actually got. Suicidal ideation are indeed disqualifying. And we don’t even know what the other “nasty stuff” is. I always presume we get at most half the story in these posts. But from just what the OP says here I don’t believe they ever qualified for a medical and thus wouldn’t be eligible for basic med.

That ship has sailed, though. The FAA can no longer take action on the expired medical. I believe, though, that they could take legal action and assert that he falsified a federal form and yank his pilot's certificate.

 

[Blookite2]

Thanks for the continued responses. I was already on a hiatus when i found out about my records so what i've been doing is just continuing to do nothing until i know exactly what the plan is.

The other nasty things i already touched upon but the suicidal ideations were the most damning IMO. The next significant incident was having police called on me after a verbal fight with a parent and i grabbed their wrist for 1-2 seconds to stop them from walking away from the conversation when i was 13. This parent actually had a history of calling the police for verbal arguments and acknowledges now that they overreacted by calling police on me. They were shocked this was even recorded anywhere. Again, this is listed in the notes section of my visit which diagnosed me with adjustment disorder.

Again, 99% great relationship with both parents always, just went through a rough time. We are best friends today and i've taken both parents flying many times even.

I'm not interested in this basic med strategy to become a CFI because the last thing i need is to apply for a 1st Class years from now only to be denied and also have my current medical and my certificates yanked, now having wasted even more time. I would rather find out now if they will be yanked.

Maybe i have a weird perspective but i almost feel that it could be better to alert the FAA now while i have a current medical so that i can negotiate losing the medical but keeping my private certificate. If i wait until my medical expires, i think they will have no choice but to yank my private. I'm not particularly worried about being prosecuted because i self-grounded as soon as i realized the mistake and i have never flown commercially.

 

[Blookite3]

Another nasty item could potentially be a car accident i was in where i encountered black ice and had a head-on collision. I told the doctor the next day that i *think* i *may* have blacked out for a second but *wasn't sure*. So now my medical record permanently has a LOC statement in it.

Again, Dr. Bruce knows about all of this and has already prescribed me a game plan. The FAA will want to see an MRI and have all records from the EMT's. I'm not sure if the FAA will approach each of these incidents as their own independent things or if they will combine them into one generally negative picture of me and have it influence their decision to accept my HIMS evaluations.

 

[Lindberg]

Thanks for the continued responses. I was already on a hiatus when i found out about my records so what i've been doing is just continuing to do nothing until i know exactly what the plan is.

The other nasty things i already touched upon but the suicidal ideations were the most damning IMO. The next significant incident was having police called on me after a verbal fight with a parent and i grabbed their wrist for 1-2 seconds to stop them from walking away from the conversation when i was 13. This parent actually had a history of calling the police for verbal arguments and acknowledges now that they overreacted by calling police on me. They were shocked this was even recorded anywhere. Again, this is listed in the notes section of my visit which diagnosed me with adjustment disorder.

Again, 99% great relationship with both parents always, just went through a rough time. We are best friends today and i've taken both parents flying many times even.

I'm not interested in this basic med strategy to become a CFI because the last thing i need is to apply for a 1st Class years from now only to be denied and also have my current medical and my certificates yanked, now having wasted even more time. I would rather find out now if they will be yanked.

Maybe i have a weird perspective but i almost feel that it could be better to alert the FAA now while i have a current medical so that i can negotiate losing the medical but keeping my private certificate. If i wait until my medical expires, i think they will have no choice but to yank my private. I'm not particularly worried about being prosecuted because i self-grounded as soon as i realized the mistake and i have never flown commercially.

If you're concerned about certificate action, and it's a valid concern, you should consider retaining an attorney who deals with such matters, like @midlifeflyer .

 

[Dry Creek]

Is it just me, or does the list of omissions seem to expand with each new post? Sort of like Mary Lou Retton; "Oh, and another thing".

I have heard that confession is good for the soul.