This should NOT be taken as a request for specific medical advice. Just general information. That’s it! Now, that out of the way…
Let’s say that a person was told by their last psychiatrist that what they basically need is medication management and to continue with what they’re doing now, BUT that they could really benefit from having a neurologist involved. This is because the permanent aftereffects of a traumatic brain injury are very much part of the ongoing picture, and always will be. Now, let’s say that this hypothetical person moved 2,500 miles, and is now looking for a new doctor. What should this-person do, seeing as how the insurance plan sucks? Just look for a new p-doc who will do med management? Can a neurologist prescribe psych meds? (Please keep in mind the suckiness of the insurance…)
Qadgop the Mercotan is a doctor in case you didn’t know so that is good advice. From the patient side, a person in this situation should realize that psychiatrists are all over the place in terms of their practices and sub-specialties. Neurology and psychiatry are two fields that should obviously go hand in hand but it wasn’t always treated that way so you get a range of skills in one or the other.
I have a fair amount of experience in finding a doctor like you inquire about. That type of doctor would usually be found associated with a hospital, probably a teaching hospital, and not just in private practice. Your best bet is to ask about cross-training and referrals for the best doctor that has dual specialties in the issue at hand. They do exist because the fields are becoming more merged like the good doctor above stated.
That’s really good advice! This theoretical person may not be able to find an in-network provider anyway because of the Insurance of Satan, so she/he/it may just need to go with the best choice (oh evil, evil, evil Humana.) OTOH, every SINGLE doctor on that supposed provider list will be called. Oh yes, they will be called, all 514 of them, even though the list seems to be about 8,000 years out of date.
Anise, a federal law is in force now that psychiatric illnesses have to be treated with parity by insurance companies. They can’t pay any less than they would for other physical illnesses. (I hope that may help a little.) They may have some ‘splainin’ to do if they don’t have in-network psychiatrists or even neuropsychiatrists.
This law was passed during the first year of the current Administration.
I think a neurologist would be useful in determining which parts of the brain were affected by the trauma. But psychiatry is mainly about symptom management. If there is an obvious connection between the trauma and the symptoms, that might be useful but otherwise you are throwing darts in the dark. At least that’s been my experience.
Another idea is to find a psychopharmacologist - someone who specializes in the neurological affects of medications. They will be on top of the latest research and any clinical trials due to open up. A good teaching hospital will have someone like that on staff but you will have to go through one of their psychiatrists most likely. On the plus side, such hospitals often accept any type of insurance - even Medicare and Medicaid.
I’ve had back problems for many years because I have bulging discs. A few years ago I was seeing a orthopedic surgeon and surgery was one possibility. Not being a fan of someone cutting on my spine and after losing weight and working on ab strengthening my back pain got much better and I stopped seeing him. Fast forward to now… Back pain again. Just had an MRI and of course it shows several bulging discs. However, this doctor is sending me to a neuro surgeon. Why am I not referred to a orthopedic specialist again?
It didn’t occur to me to ask my doctor but I will ask the neuro guy when I go to see him. Is this the new thing for people with my condition? Just curious. No hijack inteneded!
NOLA, Neurosurgeons generally do more work with the spinal cord and nerve roots. While many orthopedists also take training in that sort of work, most garden-variety orthos don’t like to touch that area.
Thanks for the response Doc. Can you point me in the direction of researching the prognosis/success rates of surgeries on bulging discs? I see lots of stuff online but not sure which are trustworthy. I realize they can’t make any promises.
But the thing about Humana is that because the plan is not sold in Oregon or Washington, it’s turning out to be very difficult to find any doctor who will actually take it (I moved from Tennessee.) Out-of-network has a $10,000 deductible (break for demented laughter…) So I just don’t think that whether or not something has parity is going to make the difference. As it has stood for years, I am uninsurable if I dropped Humana and tried to get something that doctors will take here.
HOWEVER, there is something else… I have read the TEXT of HR 3590 (PUBLIC LAW 111–148—MAR. 23, 2010), (long… 930 pages…) and once Subpart I, Section 2704 goes into effect, it simply won’t be legal anymore for any insurer to deny coverage to any person who applies because of any pre-existing conditions, OR to jack up the premiums to an insane price. For individuals buying coverage, there are absolutely NO “grandfathered in” exceptions whatsover. The only way to see this is to read the law, because God only knows what’s out there from second, third, fourth, zillionth, etc., – hand sources. I highly advise going to thomas.gov and downloading the pdf. But I haven’t been able to figure out yet exactly when this provision is legally required. It’s got to be buried somewhere in those 930 pages… (still reading)
Anyway, I’m starting to think that’s the only way I’m going to get the kind of treatment I actually need here. I may just have to settle for someone who will do basic med management first.
That’s a whole thread in itself. Suffice it to say for now that I’m very, very leery of sending my patients for lumbar laminectomies, as the outcomes are usually far less than ideal. And by that, I often consider a good outcome to be that it doesn’t hurt more after the surgery.
