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First knock down with insurance company...

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Posted 8/10/2010 7:26 AM (GMT 0)
Dear Family,

Today I got my first rejection from the insurance concerning the spinal stimulator. I was very ill and had to reschedule my psych eval and that was what they were upset about. My rheumy wanted to try me  on a medicine called Avara. It is used for rheumatiod arthritis patients but she says that she has had good results with some lupus patients and their chronic pain, swelling, and lethargy. After about 48 hrs. on the medicine I was in so much pain that I could barely hold a toothbrush in my hand. I was in bed for 3 days in that painful "haze" where you are sort of asleep but not really asleep. I called the doctor and she said to stop the med. about 48 hours after stopping the med I felt much better. I had a couple of good days and then another 2 days on the couch with pain all over again. So I called the rheumy today to give her an update as she requested and I told her nurse that now I wasn't quite sure that the medicine had caused the problem and that maybe all the stress has set my fibro off and that I'd be willing to give the med  another trial if she wanted. So now they have to get back with me. Now for the second time in a row my urine has too much protein in it and I have to do another 24 hr. urine. I asked to have the lab results sent to me and I think that I'm going to do that each time I have lab work done. I live 2hrs. away from this doc and at least that way I have all of my current labs with me in case something happens and I have to go to my local hosp. I haven't been able to use the computer so I haven't read many of notes of what is going on with each of you.

WhiteBeard, I'm like you....I can't tolerate the heat or humidity anymore. It makes me physically ill if I get too hot. It might be this Fentanyl patch I'm wearing.

I am having my psych eval next Mon. and I dread it. The questions that they ask on the form are extreamily personal as expected but there are things that I would rather not get into. Such as physical abuse or rape. That happened to me 32 yrs ago and I don't want to discuss it now and I don't see how that has anything to do with the stimulator. I'm so upset about this interview now after reading all of the questions.  Oh well, I'll do what I have to do I guess.

Love to each of you and many prayers are said for you each day.

Nurse 2

Posted 8/10/2010 7:59 AM (GMT 0)
Nurse2 I am sorry to hear that you are having such problems. Jeesh, you need a break so bad. Something I want to bring to your attention about the Fentanyl patch and you getting physically sick in the heat. If your body temperature rises from getting overheated then the patch releases too much medication and that will cause you to feel ill, and the patch will not have enough medication left in it to last the full three days causing withdrawals. I went thru this when I wore the Fentanyl patches  and it wasn't until after I was taken off of them that we realized what was going on. However, this is not the reason I was taken off of the patch. It will be interesting if your dr wants to try you on the other medication again.

 

I totally understand your feelings about phsych eval. I had to go thru all of that when I had my pain pump put in. Medtronics requires the evaluation on people getting pumps and SCS units. My insurance had nothing to do with me having the psych eval. Just try your best to stay as calm as possible and you will do just fine on your eval. Hugs.

Posted 8/10/2010 8:58 AM (GMT 0)
Nurse2,

I'm sorry for all of the things you are struggling with :( I, too, had to do the psych evaluation when I had the pain pump trial; yes, it was hard to go over lots of painful past stuff... mainly, though, the person who did mine focused more on if I was currently *mentally stable* and if I understood the procedure I was about to undertake... so let's pray that your person has the same focus. Let us know how it goes... I will be thinking of you.

I'm w/ you, White Beard, and others here. I can't do the heat or humidity at all... The last 7 years, my kids just *know* the temp in our house can't go over 71 or it makes mom sick. Sometimes, in the middle of summer - they'll have sweatshirts on in the house.... :) The heat makes everything flare for me - especially my heart issues.

Finally, I think it's a good idea that you get your lab work directly sent to you... I do that now, too. I've been told several times that my labs came back "fine" - only to get a copy and see several things that WERE off. So, now, I just always get a copy sent to me, too...

My prayers are with you..... and, again, thanks for sharing about your twin girls... I appreciate the encouragement that I WILL make it through this :)
--Tina
Posted 8/10/2010 6:09 PM (GMT 0)
Nurse2,
Yes, like Straydog & Mom have said, the psych eval is standard for most of these procedures. One thing I would be sure to do is let this doctor know right off the bat what meds you are on, and especially recent side effects you have been having. You may even want to take a copy of recent lab reports. You want some documentation since your thought process, etc., during the interview likely will be affected by the meds. So often that's forgotten.

If they make you take the MMPI (the really, really long test with a few hundred questions) again be sure to let the doctor know - not aggressively, but nicely - of any difficulties you are having with anything from thinking, lethargy, sitting, etc. and ask this be noted. A decent doctor would take all this into account when interpreting any test results, and will include it in the report. However, some of these docs work for insurance companies and the outcome tends to be pre-ordained. Or as with another member here, despite a positive psych eval her W.C. is still giving her hassles.

I'm not saying this to increase your anxiety, but to try to do the opposite. If you can go in with the understanding that the interview will likely be affected by your state of mind, and whatever side effects you may be experiencing from your meds, and communicate that nicely, it's more likely to get documented.

As far as your past history, you don't want to lie, but you should have the right to say how long ago that happened, and that you prefer not to discuss it. HOW you say that will matter a lot. If you're angry or defensive, or too emotional, that may work against you and be viewed that you haven't dealt with it. If you've had any prior therapy for it, even if it was years ago, be sure to tell the doctor. That would go a long way to helping support your not wanting to discuss it for valid reasons. Plus, the details shouldn't be relevant in just an evaluation, although old traumas in our lives can affect us in ways we may not realize as adults. There won't be any way to really hide that, but all you can do is your best. Just remember that. I'd be more concerned about the medications you're on and how they're affecting you currently, and try to have him/her focus more on that.

Just be you. You're not trying to hide anything, and we know that. Be confident in yourself, and that you can only do what you can do. And the doc's either going to be decent and understand, or not, and you have no control over that.

Good luck - and let us know how it goes!

PaLady
Posted 8/11/2010 1:37 AM (GMT 0)
Nurse2,

Don't give up your hopes for an SCS yet. You might have to fight, but it's worth going through the appeal process if this is really something you want to try. I had to fight my insurance company for 6 mo & go through 3 appeals before they said yes to me. If I hadn't won after the second second appeal (they granted me a new second level appeal after some special circumstances regarding how my doctor's office handled my appeal poorly), I was prepared to go to my state Insurance Commissioner.

If you have a choice, I'd highly suggest going through an in-person hearing vs an on-paper appeal, that way you have to force them to face you & your unique situation.

hugs,
Skeye
Posted 8/11/2010 3:51 AM (GMT 0)
nurse2
You know maybe I am missing something, but I just don't get the reason for the psych eval for getting a stimulator??? They don't do that for a pace maker do they??? I have never heard of them doing it for that anyway. Do they require that for a TEN's ???? Noooo! So what is the big deal about this stimulator that requires this psych eval??? I mean think about it, can you really do anything with it that would harm you,???? Doesn't the Doctor set the thing up???? What am I missing here?? As far as I know it is pretty much like an implantable TEN's unit isn't it? I have alway been baffled by this requirement, and why on Gods green earth would the manufacturing company require having it, unless they use the data for marketing.

Anyway just know nurse2 that we are all here giving you all our support. As a side note, my out door thermometer read over a hundred today and our humidity levels are up close to 80% it is terrible out side ! They say no relief till maybe this weekend!! I keep my AC at 67 or 68 and it was really straining to keep the house at 70 degrees by late afternoon. I stay inside, I am thinking about closing all the curtains tomorrow and putting on White Christmas or Its a Wonderfull Life or something on the VCR just to think cool thoughts, and forget about this heat! I have done it before and it really helps!

I keep you in my prayers nurse2, I do hope they can help you with your pain.

White Beard
Posted 8/11/2010 4:48 AM (GMT 0)
WB-
imho, those sneaky people require it to rule out the "malingerers" and people who are likely to sue them when their so-so product fails to provide any relief or causes more harm than good. People put a lot of stock in these things & they really only help certain types of pain & then only to a certain extent, at certain times, in certain positions.

in spite of being a so-so treatment, they seem to have comparatively few lawsuits from what I've seen. I don't have any evidence but I have to wonder whether that might be one of the things they're looking for with those interviews.

i agree with you, though. why do they need it? people are just all WAY too nosy these days. i'm applying for a web design job & for pre-employment they run a motor vehicle record request with insurance companies, a workers comp search to see if you've ever been involved in one, plus the standard criminal background, credit check & drug screen. I had to sign a waiver agreeing to submit to a polygraph test at any time upon request -- and this for a tiny, tiny nonprofit. I think people are just way to concerned with other people's business these days. what the heck does my driving record have to do with anything?! I don't even own a car anymore b/c I'm walking distance from work. the whole thing is dumb as rocks. one accident so long ago the insurance companies don't even hold it against me & HR is saying that they might not be able to hire me now.

maybe they're lying little devils just looking for reasons to try to lower my pay, but the whole thing just enrages me. Whatever happened to the days of privacy?
Posted 8/11/2010 9:35 PM (GMT 0)
Nurse2, I'm so sorry. Sometimes, insurance companies just suck. Mine pays for a general rehabilitation programme where I'm going to be thrown in a room with people who had heart attacks, with people who have back problems or had a stroke - that will only help me so much. What they won't pay for is what I really need which is intensive weight training with my legs.

Generally, it sometimes seems like insurance companies, like everyone else these days, just want to save as much money as possible, even if people suffer. In Germany, the health system is undergoing a reform which is scary because we'll have to pay even more and will get less out of our health insurance.

My best wishes to you and hopes that the psych evaluation goes well.
Posted 8/12/2010 2:19 AM (GMT 0)
White Beard, Nurse2, & all,

In addition to what Frances said, I think insurance companies have a vested interest in the psych eval as well. Like Athas said, they want to save as much money as possible. So if they can eliminate some of the candidates from the get-go, then they won't have to pay for the procedure (which, from experience, I can tell you, is very expensive).

However, I actually do think that the psych eval can benefit the patient as well. A successful trial of a neurostimulator is defined by 50% relief or greater. Stimulators are NOT miracle cures & the patient must understand that.

That all being said, I'm still not clear as to WHO requires the psych eval. I know Susie said that it is required by the company that makes the stimulator, but I'm not so sure that that is the case, as like Susie's pump, my stimulator is a Medtronics & a psych eval was NOT required for me, whereas it was for her. In pre-op, my Medtronics rep did ask me what I expected to get out of the trial & I'm fairly sure that if I had told him that I expected to be cured 100%, he would have had issues with my going forward with the trial, but no formal evaluation was ever required of me.

Skeye
Posted 8/12/2010 2:24 AM (GMT 0)
Okay, I just found this on the Medtronics website under a Q&A about patient selection for neurostimulation:


"Q: Is a psychological evaluation a requirement for patient selection?

A: Psychological factors have a significant influence on many chronic pain disorders. Psychological evaluation serves several purposes. It can identify psychological "risk" factors; facilitate treatment of these risk factors; facilitate patient selection to the extent to which there
is a physiological origin of pain; and provide insight into a patient's response to a screening test or treatment. The need for psychological evaluation will vary according to the nature of the patient and the nature of the pain being treated. Psychological evaluation may be invaluable in an individual with non-cancer pain, especially if the patient's history suggests the presence of psychological factors that might complicate a good outcome.

Psychological factors that are considered exclusions for implantation include active psychosis, major uncontrolled depression or anxiety, active suicidal or homicidal behaviour, serious drug or alcohol addiction problems, and serious cognitive deficits. Other factors that may be cause for exclusion or caution include unusual pain ratings, certain personality disorders (e.g., borderline or antisocial), somatisation, litigation related to the pain disorder, lack of social support, and unrealistic outcomes expectations. In some cases, these factors can be viewed as risk factors, rather than exclusionary criteria, and might be modified through psychological intervention to promote a good outcome.

The role of the psychological evaluation is not to "rule in" or "rule out" a patient, but to identify patients in whom overall quality of life is likely to be significantly improved by a treatment plan that includes neurostimulation. The frequency with which a psychologist identifies previously unrecognised risk factors varies with the experience and expertise of the referring physician and the psychologist, but is sufficiently common to warrant psychological evaluation of most,
if not all, candidates for neuromodulation therapies."

www.medtronic.com/IN/physicians/pain/neuro/faq.html

Skeye
Posted 8/12/2010 12:41 PM (GMT 0)
Thats interesting Skeye because on their site under the heading is the Device Right for You on pumps & stims one of the reasons listed to be a candidate is "if you have passed a psychological exam." My pump implant was done in 1995 and at that time Medtronics did require the exam. So now, they have it listed both ways, which makes me wonder what they are up to by doing this. From what my dr told me back then it was mainly used to verify the patients expectations of the device, as early on wih pumps there was some litigation over the results not being what the patient understood they would be. After that Medtronics required the exam on all pumps. Everyone I know with a pump had to have the eval done for that reason. I really don't understand the need with stims since there is no medication involved like with pumps. We have had a couple on here not sure of the mfg of the stim's that did not do a psych eval, maybe FatherJohn???

PS: I was looking at this face page on what Skeye copied and it was different from the one I just looked at, at Medtronics. The info that Skeye has copied for us is from a Medtronics office located in India. Perhaps there they don't require the psych exam. But, if you type in www.Medtronics.com which is the one in the states it is listed as part of a requirement for both devices. Only thing I can figure with you Skeye is maybe it was just something that fell thru the cracks.

Anyway, Nurse2 I feel you will be just fine and try not to stress over this. It is one more step towards perhaps something giving you some long overdue relief.

Susie

Post Edited (straydog) : 8/13/2010 2:07:46 PM (GMT-6)

Posted 8/12/2010 9:13 PM (GMT 0)
That's good info. Skeye posted. I don't know much about pumps and stims, except what I've learned here, but a psychological eval. is becoming the 'standard of care" in most all major procedures these days. That means that doctors that don't do it may be subject to scrutiny or even legal or ethical actions for not referring for a psych. eval. I'm mostly familiar with them for gastric by-pass surgery. Initially, psych. eval's weren't required for those, but then doctors started seeing problems with outcomes due to emotional issues that hadn't been dealt with which affected the eating disorder. My guess is it's similar with pumps and stim units because of both medical reasons and, from the insurance company perspective, financial. These are expensive procedures, as has been noted, so if there are medical/research criteria that indicate certain psychological factors impact outcomes, a psych. eval actually makes good sense. Expectations for how much a stim unit may help can certainly be impacted by psychological issues, even if someone says they openly understand the limitations.

Just my two cents. :-)

PaLady
Posted 8/13/2010 12:21 AM (GMT 0)
I'm not sure anyone is actually requiring these psych evals, but it seems like everyone thinks someone else is requiring it so they just mandate them & blame them on someone else.

My own insurance company did not require it for me, but my PM's office swore that they did so they ordered a psych eval. However, I know other patients with the same insurance company who had a written letter that stated the opposite of my letter -- it said that they had to get a psych eval. The whole thing is bizarre. I agree that patients need to have realistic expectations. This isn't even close to a miracle cure. But why can't PM's evaluate for that? They evaluate people for pretty much every other procedure -- including ones that are much riskier, much more expensive & much more likely to give lousy results (e.g., fusions). So what's the deal with the SCS psych evals?

Nurse,
I told them I had a decent childhood. I've learned the hard way not to mention abuse or anything like that. It biases the interpretation of the results in a way that is adverse to the patient. Giving the same answers twice to 2 different researchers & only changing info about my childhood from "it was a living hell" to "it was fine" meant that I wasn't labeled a sociopath the second time but a loving, albeit somewhat naive, highly religious person. Yeah, figure that one out.
But that's just me. Only you know what's right for you.

good luck with round 2!
frances
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