Mental Nervous exclusion

[saildawg]

My wife and I both obtained our DI own occupation (principal) in residency, now being 3 years out I am reviewing my policies.  At the time my wife was taking adderall for ADHD, and they slapped on a mental/nervous exclusion.  She has not refilled a prescription in over 2 years, so I am asking for it to be removed.  I was/am taking propanolol prior to microsurgeries (which was done by everybody in my residency, probably more of a placebo effect but too scared to let it go).  I was also slapped with a mental/nervous exclusion.  I am asking for an exclusion for my wife as she no longer uses the medicine, and I feel like I should have never accepted my exclusion and wanted opinions here if people think this is reasonable.  I kind of feel like a fool because I would imagine mental stress would be one of the most likely reasons to have disability in our profession.  My questions

1)Could I ask for my exclusion to be removed even if I stil take propanolol?

2)If I try to find another policy with an independent agent, will the fact that there was an exclusion in my previous policy hurt me, make it impossible to have exclusion free in my next policy?

3)How much of a pain is it to obtain new policy and cancel previous?

I always have a feeling I got a bad deal with my current DI, and not sure the insurance agent was truly independent.

Thanks

[Hatton]

I am sure that one of the knowledgable disability insurance agents will respond to this as well.  I think most insurance companies really investigate claims for disability exhaustively now.  I even know one doc who was getting it and then the company denied her claim 4 years in.  She went back to work.  (In all honesty I thought her claim was bogus.)  I think lots of docs have trouble with depression and anxiety but not to the point of a disability.

[saildawg]

I still think the point is that disability is expensive but provides you with some psychological well beaning that if something did happen you and your family would be provided for.  If you have exclusions that does not really provide that same benefit, especially if it is for something stupid like taking adderall or propanolol

[hightower]

I agree it's total BS that they can write in exclusions like that.  I wish there was a way that people could receive completely anonymous medical care that even the insurance companies couldn't find out about.  Reminds me of a lawyer/physician we met in medical school who ran a private psychiatry practice that was cash only and purposefully non-hipaa compliant.  Pretty bad ****************** really.

Anyway, there's probably nothing you can do about it now.  The information is out there that you once took those meds.  If it makes you feel any better they did the same thing to me with my life insurance because I had taken an SSRI for anxiety for a few months during residency (which I regret now because I believe SSRI's are harmful and don't fix anything).  They wrote in a suicide clause on my life insurance.  I actually don't know if they did anything to my disability insurance.  Anyway, I have since found that mindfulness meditation, Eckart Tolle, and exercise help me deal with all the stress of everyday life as a doctor. With those tools I feel I'll never need to use my disability insurance for anything psychiatric.

[VagabondMD]

Over the years, I have received counseling for stress and burnout related issues, on and off. I always paid cash and never made an insurance claim. Some things are best kept out of medical records and health databases.

I have had more than one physician colleague who wanted to have a cancer screening body CT. (The data does not support doing so, but if someone educated wants it, I have no problem doing it.) They have generally paid cash and have had the exam done under an assumed name.

[Scott at MD Financial Services]

Generally speaking and of course there are exceptions by different carriers from time to time but once again generally speaking here are the rules for M/N issues:

1:  Currently on any anti-depressant Meds for any reason, client gets 50% rate up, 5 year benefit period, full exclusion and no future purchase options allowed.

2:  Not currently on Meds but have taken them in the last 2-3 years then carriers will sometimes do a rate up but age 65 benefit period is in play, full mental nervous exclusion and about 50-50 on the future purchase options, depends on if it the Meds were taken for a long time, situational issue, or were just occasional usage.

3: Not currently on Meds and have not taken in 5+ years then there is typically no modifications to a policy.

It is easy enough to have a simple medical narrative written by you then have a rep send to each carrier for their review.  Once we get that review back we typically present our clients what their options appear to be based on that narrative and if one of the options look appealing then we submit to that carrier or go back to the exiting carrier for modification releases.

Let me know if we can help further.

[Zaphod]

saildawg wrote:

My wife and I both obtained our DI own occupation (principal) in residency, now being 3 years out I am reviewing my policies.  At the time my wife was taking adderall for ADHD, and they slapped on a mental/nervous exclusion.  She has not refilled a prescription in over 2 years, so I am asking for it to be removed.  I was/am taking propanolol prior to microsurgeries (which was done by everybody in my residency, probably more of a placebo effect but too scared to let it go).  I was also slapped with a mental/nervous exclusion.  I am asking for an exclusion for my wife as she no longer uses the medicine, and I feel like I should have never accepted my exclusion and wanted opinions here if people think this is reasonable.  I kind of feel like a fool because I would imagine mental stress would be one of the most likely reasons to have disability in our profession.  My questions

1)Could I ask for my exclusion to be removed even if I stil take propanolol?

2)If I try to find another policy with an independent agent, will the fact that there was an exclusion in my previous policy hurt me, make it impossible to have exclusion free in my next policy?

3)How much of a pain is it to obtain new policy and cancel previous?

I always have a feeling I got a bad deal with my current DI, and not sure the insurance agent was truly independent.

Thanks

Click to expand...

Your residency promotes taking a beta blocker for microsurgical cases? That is one of the craziest things I've ever heard. Besides the obvious that if you dont have a need for a med you shouldnt take it, the issues you're having now should be a prime reason to never do anything like that.

Is there even evidence it makes any kind of real difference? Its a whole lot easier to have anesthesia pause some breaths during critical throws, but in reality its just better to learn how to do so in your totally normal state.

I'd try to fight this however, and say you dont need nor use it at all. It was a suggestion, blah, etc..

[Hatton]

I have a friend that runs a part time practice called "off the grid".  People in my area who need a security clearance for government contracting jobs use it.  No insurance, anonymous.  I had no idea that anti-depressants would increase your DI rate so dramatically.  I guess I better stop prescribing them for PMS.  Stuff like this is another reason to get DI as a resident.  I guess we are caught between physician suicide risk or getting a deal on DI.

[saildawg]

Zaphod wrote:

saildawg wrote:

My wife and I both obtained our DI own occupation (principal) in residency, now being 3 years out I am reviewing my policies.  At the time my wife was taking adderall for ADHD, and they slapped on a mental/nervous exclusion.  She has not refilled a prescription in over 2 years, so I am asking for it to be removed.  I was/am taking propanolol prior to microsurgeries (which was done by everybody in my residency, probably more of a placebo effect but too scared to let it go).  I was also slapped with a mental/nervous exclusion.  I am asking for an exclusion for my wife as she no longer uses the medicine, and I feel like I should have never accepted my exclusion and wanted opinions here if people think this is reasonable.  I kind of feel like a fool because I would imagine mental stress would be one of the most likely reasons to have disability in our profession.  My questions

1)Could I ask for my exclusion to be removed even if I stil take propanolol?

2)If I try to find another policy with an independent agent, will the fact that there was an exclusion in my previous policy hurt me, make it impossible to have exclusion free in my next policy?

3)How much of a pain is it to obtain new policy and cancel previous?

I always have a feeling I got a bad deal with my current DI, and not sure the insurance agent was truly independent.

Thanks

Click to expand…

Your residency promotes taking a beta blocker for microsurgical cases? That is one of the craziest things I’ve ever heard. Besides the obvious that if you dont have a need for a med you shouldnt take it, the issues you’re having now should be a prime reason to never do anything like that.

Is there even evidence it makes any kind of real difference? Its a whole lot easier to have anesthesia pause some breaths during critical throws, but in reality its just better to learn how to do so in your totally normal state.

I’d try to fight this however, and say you dont need nor use it at all. It was a suggestion, blah, etc..

Click to expand...

I wouldnt say they promoted it, but it was common thing to do.  Especially when learning microsurgery it did seem to take a little edge off.  Much like when people use B blockers prior to publicspeaking etc.  Common practice from other collegues at other institutions as well.  Anyways, we are beside the point here.  I wouldnt do it again, I also have heard that there is only a 2yr bennefit for mental disability for own occupation I find that hard to believe, I need to review my policy details.

[Scott at MD Financial Services]

The carriers are getting better about it, 10 years ago if you one was on meds or had been on meds in the prior 5 years that person was simply a decline.  I think in the 2-5 years most carriers will just simply exclude M/N claims and not have Future Purchase Options for those on meds or within 5 years of meds....but that is just my opinion.

[Craigy]

These exclusions basically make disability for anesthesiologists, etc. a non-starter.  Mental/nervous exclusion is a huge swath of the disability arena.  Basically like saying "we'll cover the right side of your body but not your left."  You're paying the same premiums as everyone else (sometimes more) but only getting about half the coverage.

[saildawg]

Craigy wrote:

These exclusions basically make disability for anesthesiologists, etc. a non-starter.  Mental/nervous exclusion is a huge swath of the disability arena.  Basically like saying “we’ll cover the right side of your body but not your left.”  You’re paying the same premiums as everyone else (sometimes more) but only getting about half the coverage.

Click to expand...

Yes my point exactly.  Why would I pay same premiums for less coverage?  As a surgeon I am happy with physical protection, however I had a friend have a terrible outcome from routine case involving a child and has symptoms of PTSD.  We call it "Burnt out" here, but really it is PTSD and I cant imagine practicing for a while after what he went through.  Frustrating to think that it wouldnt be covered, as it is really disabling.  I think this is a strong reason to achieve FI ASAP so you can self insure

[Antares]

Vagabond MD wrote:

Over the years, I have received counseling for stress and burnout related issues, on and off. I always paid cash and never made an insurance claim. Some things are best kept out of medical records and health databases.

I have had more than one physician colleague who wanted to have a cancer screening body CT. (The date does not support doing so, but if someone educated wants it, I have no problem doing it.) They have generally paid cash and have had the exam done under an assumed name.

Click to expand...

As a psychiatrist, I think that is wise. If someone came to me under those circumstances, my notes would be handwritten on paper and would never get out into a database anywhere. And if you never mentioned it on your application, I would never get a request for information. I never send copies of my notes to insurance companies anyway. I write them a summary which allows me to describe the situation in a way that I feel is more fair to the patient, and the insurance companies seem happy with that. Of course, if a prescription is filled, that's on the record regardless. Actually, I wonder whether you might get around that by having it filled and shipped from Canada? Have to look into that. Of course there is always the risk of voiding your policy if somehow it is determined that you withheld information. The system sucks when it comes to psychiatric issues. I have seen many situations where someone is denied because they took or take medication, and I believe them to have no greater likelihood of psychiatric disability than anyone else, or less.

[pistolpete]

Psychiatric conditions are still stigmatized, unfortunately. It's sad to see as a psychiatrist. Depression is a medical illness in my opinion, just like hypertension. It is what it is.

[Scott at MD Financial Services]

PistolPete,

You are exactly right and just the same if someone had prior knee surgeries they will have an exclusion on that as well.  The reality is someone with an issue (regardless of the issue) is less favorable of a risk then someone without an issue so the carrier has kind of 3 options to level the playing field, charge more, exclude the issue, or just decline the case.  Personally, I am glad that the carrier puts options on the table vs. a decline.  Many people have in the past or presently do take these medications, especially during residency I am glad that the carriers now have options vs. just declining the case as the carriers use to.  One may not like the options but at least having options is better than not having options.