[Shadow Wraith]

Please let me know if you all have had similar experiences and suggestions regarding psychotropics meds and doctor bias against the "mentally ill". I have been taking Xanax XR for well over ten years at 3 mg. The dose has remained at 3mg for almost that entire period of time. I have had the therapy continuity through every doctor I have seen over that period of time. I feel very upset, dissapointed, and worried about whether I am going to be dealing with sudden withdrawal effects since it is becoming extremely difficult for me to continue what has been working for me for all of this time. I struggle with being hyper-sensitive to stimuli. As a result, I get startled very easily. I feel overwhelmed by everything at once. This has resulted in panic disorder in which I can just start having an escalated startle response at seemingly random times.

Anyway I digress. The primary care physician I had was very understanding and supportive of my treatment. One would think that if it isn't broken, why fix it? When I've tried well over a dozen different medications (including SSRI's) and they didn't help anywhere else, why change everything? Well, the physician I was seeing is apparently having a dispute with the company he has been working with. Therefore, he has decided to take some time off to deal with this apparently financial issue. So now I have seen his colleague and therapy has continued smoothly for my medications. Right? Not so much. He has decided I need to have a psychiatrist monitor my medications. All of the other medications, save Concerta, are not altered by the doc. One of them, Lyrica, is even a controlled substance as well. He doesn't have a problem with that. Speaking of Concerta, I need to see a psychiatrist for that as well. Nevermind the fact that it is used for daytime sleepiness first and ADD on a secondary level. I have taken it over a year. I feel so angry about the fact that it's perfectly ok to him to just brush me off and send me to a specialist without even an explanation. All of this was handled through his PA. I have an appointment with this doc in 2 days. My wife has not had any trouble having Lorotabs prescribed for her for her pain. Why not send her to a "pain specialist". I am not given a reason.

Well, I go see my psychiatrist. I arrive at my appointment after using most of my fuel. The office manager gets upset with me asking about seeing where the over 90 day policy is in writing. If I were at any other one of my doctors and ask such a question, they would simply respond. I was being very polite and respectful. Instead of getting to see my psychiatrist, the office manager unilaterally says I can't see my psychiatrist. When I mention that I don't mind waiting to speak to my doc or arranging to see her later about this situation, she threatens to get the security guards to escort me out. This has never happened to me. I'm taken aback. It seems like I am treated like pond scum for daring to as a question that a "normal person" would ask.

To get to my main concern, what am I supposed to do? What do I say to the doc on Monday when I see the doctor? What do I say to keep from coming across as someone looking like a desperate addict despite no record of any abuse of any drugs, ever! I can't afford to see a psychiatrist on a regular basis. Is there any organization that could help? I really don't know what to do.

[ECHOES]

Sorry that you had such trouble.

I don't follow about the 90 day rule question. What is that about?
Asking a question resulted in having security called? What happened there? Something is missing.

[pgrundy]

Are you referring to a payment-in-full within 90 days policy? I have noticed over the past couple of years many specialists, ESPECIALLY psychiatrists, have become quite unpleasant about this. My own psychiatrist demands payment in full UP FRONT even if you have insurance, and won't even see Medicaid patients. There are signs all over the office. It's not fun or nice.

On the other hand, I keep going to him because he's awesome. Every time I go to a GP to save money something awful happens because, nice and (relatively) affordable as a GP can be, they don't have the training to dispense psych meds correctly. So I think your doc is probably right--a psychiatrist would be good for you--but how to get into one?

It's insane. The medical situation in this country, especially for people with mental illness, is cruel and unusual, and... insane.

I am sorry you are going through this. Could you ask your GP office for help with the situation? Sometimes they will mitigate. Good luck to you.

[missbelle]

I don't know what the 90 day rule is either but I do know I owe a lot of Doctors here in Northern Virginia. I f you have a balance they usually want to be paid before you go in for the next appt. even if it is a small balance.For instance I owed my Neurosurgeon 54.00 and I had to pay it before I saw him again. It had been a while since I last saw him.
I do know Dr's don't like to talk about fees, balances and leave it up to the office manager to do that kind of stuff.
I know in the past I have not always paid the Dr's. I felt that since I was so poor, that they had more then me and didn't need it anyway!!!. I was really wrong in how I felt! They provided a service to me, sometimes extremly good, and by shear principal I had the obligation of paying them as best as I could. A lot will work out a payment plan for you. I always found that very difficult to ask for that but now its not so difficult. I think when you get a Dr. you need to know exactly the fees and how and when things should be paid and their payment plans and options

I actually feel some Physicians and Psychiatrists are having as much financial issues as the patients.(well maybe not as much) Here in Northern Virginia, my grandson has a pediatric orthopaedic surgeon and now there are only two in the Northern Va area that now treat. The rest have all moved out and left...no money!

Life here is getting difficult for all of us isn't it?

I hope things work out for you because I could not live without my meds either!!!!!

[Shadow Wraith]

I apologize for not being more clear about the 90 day rule. I didn't have a past due balance. I had a 0 balance since I have always paid my copays as required. The issue was that they said they considered anybody who has not seen their psychiatrist for over 90 days, they were then categorized as new. Therefore the copay tripled. I had seen this person for over a year. Then it was over six months before I came back.

I can see why someone would think it does not make sense that I was threatened to have security to come by if I didn't leave the office. That means I couldn't wait to see if the psychiatrist could at least speak to me about my financial situation. I then asked how I can contact the psychiatrist. The office manager then said that I can't see her because she believed I was not going to follow any office policy if I didn't follow that one policy. I never said I wouldn't pay it. I made it clear that I would be happy to pay it if I could simply see the new patient policy. I recognize that they have every right to set their policies. I'm sure they have to have some kind of guideline to determine when to consider a patient new again. I can just see a new doctor if I don't agree with their policy. I simply wanted to see it myself and see if it's possible that it can be flexible due to my lack of finances.

Here is what is "missing" or what the office manager decided was enough to threaten security on me. I said I would be willing to pay it but that I though it was unreasonable and excessive. I asked the rationale of being over the 90 day policy besides the fact it increases their profits. Keep in mind this person was condescending, rude, and dismissive about being interrupted in her office. I did "smart off" and ask does that mean if it had been 90 days I would be considered "new". I also dared to try to go "over her head" and speak to her supervisor, which was the psychiatrist. This person insulted me by saying that I was going to see the psychiatrist again because my doctor probably wouldn't prescribe for me any more.

I have worked many years with the general public. From what I've experienced, the way I behaved certainly not close to coming across as irrate, making a scene and certainly not a threat to anybody to deserve being threatened and embarassed. On the other hand, from working with the public, an office manager of all people would be professional and keep her cool. There were many times a customer, etc. would really be irrate. I didn't call security or threaten to, I would actually at least show a bit of empathy and de-escalate things.

As I've said before, this is not the first time I questioned a doctor's policy. The explained it and I would say, OK. If they just said it was policy, I would drop it in most cases. I have never had any trouble with the police or even had a threat to have security remove me. I felt like since I was seen as "mentally ill" that daring to question matters that I must be patronized and have a threat to have security called on me. I have gotten along great with the psychdoc. I had gotten along with well with other mental health workers and their staff as well. The only time I got the impression I was just another object to be called in after waiting forty+ minutes was with psychiatrists. As I said before, I'm sure there are some outstanding psychiatrists out there. I think some of it is part of their training. Part of it is managed care and the fact they get paid about as much as a family physian. Therefore, I feel like I'm walking into a pill mill only to be seen out after briefly saying how the meds are doing (which was the same every time).

[pgrundy]

Well, I went two years without meds and when I tried to get back into my psychiatrist I had to go through the new patient evaluation too. It was actually pretty helpful and I don't regret it, but it did cost more. I can see a medical reason for it that has nothing to do with profit. It's unfortunate that the office person you spoke with couldn't explain the medical side to it without escalating the issue.

It sounds like the front office person was just not very experienced or professional. But since you'll have to get past that person to see the psychiatrist you maybe have to ask yourself if that's going to work for you. Maybe a different psychiatrist would be better. Start over, stick with it--something like that.

Psychiatrists walk a thin line and face lots of liability issues. They see things from a different perspective, and they're always fighting the drug companies and the insurance companies. A full evaluation every so often is IMO a sign that you've got a good shrink there. It's just the office person who was a drag.

Good luck. I hope you can get an appointment soon.

[lost in]

if affordability is an issue, there may be other less expensive alternatives. community mental health, easter seals, catholic social services (you don't have to be catholic), and others. investigate. as for the 90 day rule, things change in 3 months. they're being careful about liability. as for the office manager, complain in writing your experience directly to her superior (be factual and honest, not emotional). maybe this is not the managers first foray into rudeness. you have certain rights (at least in my state) to see, in writing, payment, disclosure, and other policies directly affecting your treatment. best wishes on getting the help you need.