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conversation with STD provider pre-approval


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So I believe that a fair number of people posted in response to my other question about having experience with short term disability (hereinafter "STD") through a job, as opposed to SSDI/SSI land (which I know a fair bit more about just because of work stuff, ironically).  I haven't gone down the STD job route before. 

The current question, in case anyone's been there---have you had a conversation with the STD provider's representative prior to getting approved?  (Or at some sort of re-authorization process would probably be similar.)  My person called me today while I was unfortunately buying shorts in a store with way too much background music for me to be able to answer questions.  I mentioned that and asked about time to leave the store, but she said she'd call back on Monday.  I'm already worried that the being out in a store shopping will look bad--but for pete's sake, the seroquel has jumped my clothing up by about 4 sizes, so I didn't have any shorts and it's 90 degrees.

Anyway...putting aside the anxiety around delaying the call, does anyone have thoughts on what this call might entail?  Given the paperwork I gave them, which included the really crappy discharge paperwork from my very recent hospitalization for bipolar disorder, severe, manic w/ psychosis (i.e. all the buzzwords they usually care about), I'm kind of confused about what's still up in the air. 

Open to any thoughts or suggestions--and if you haven't been down the STD path but have some ideas, I'd love them also!

thanks,

dances

Edited by dancesintherain
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Not sure I should admit this but for about half the message I thought "How do you get Sexually transmitted disease" from work?  And then "Why would you write work about getting them?"   Sheesh... I gotta not read stuff after taking ambien....

 

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That part went incredibly smoothly.  I'm already off work, even though the STD part is pending.  The person I have to talk with is the third-party payor/organization who decides whether or not to approve the claim and if so, what the review schedule would be like.

In SSDI/SSI world, I've done the application pieces, gathered the info to support it, and yet still have to meet with the claims decisionmaker who has control over everything as far as granting it (other than the appeals process, which does exist in STD world also).  At least I don't (think i) have to get examined by an independent psychiatrist? 

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3 hours ago, dancesintherain said:

At least I don't (think i) have to get examined by an independent psychiatrist? 

Good question.  I think that could go either way depending on how strict the claims decision maker is in approving STD for someone.

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So I think there's really two main differences in the SSI/SSDI process versus short-term disability--with the disclaimer that I haven't been through SSI/SSDI myself and only know about it through clients/friends and that I haven't done STD myself...

1- although I have to sign a release broad enough to let the paying company access any records from anywhere and list places where they might want to access them and/or people to talk to, I don't actually have to produce them all myself.  The application is 15 pages (in three parts--me, doctor, employer)...but we don't have to toss on the supporting documentation

2 - I'm 99% sure that they don't have their own doctors and in general take the physicians at their word.  I believe the claims people are supposed to be trained enough to handle the claim without sending someone out for a second opinion essentially. 

I don't know completely, but I think both of those are true.  What I don't really know is what this conversation on Monday might be about.  Hmm...

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I'm currently on STD from work. I have not had to see any doctors other than my own. They took my pdoc at her word. I've been IP twice while on STD, and I'm doing IOP and receiving ECT (so I've seen a lot of pdocs, not just mine). I don't think the STD company has been in touch with any of those doctors, but I don't know for sure. I haven't talked to anyone from that company either. I just know I was approved because checks started appearing in the mail.

My primary comment would be to try not to worry. You weren't doing anything wrong. There's a difference between being able to do a little shopping and working full time.

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Thanks geek.  I'm glad it's mostly worked out for you smoothly.  I hope mine goes so also.  I also appreciate the perspective on shopping...I was feeling pretty much like I got "caught" but I also didn't see an alternative since its in the 90s and my shorts are 3-4 sizes too small, mostly due to seroquel.

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STD (as far as I know) won't make you see an outside doc. SSDI/SSI sometimes requires a CE exam with an outside doc and WC (workman's comp) sometimes makes you see an independent doc. I believe STD/LTD do have a few nurses and such on staff to consult with on claims that require more medical expertise, but (to me) a lot of claims seemed fairly routine to someone who processes them all the time (pregnancy, knee/hip replacements and so forth). 

I don't want to cause you any unneeded anxiety but the one phone call I actually remember when I spoke to my STD claims person was a bit unpleasant. She started telling me what I needed for my claim or maybe I asked what was still needed or what more could I provide and she went off on a generic response using terms I didn't understand, and I started sobbing and then was unable to go to work that day due to being an emotional, sobbing wreck. (I was in the process of trying to return to work and made the mistake of answering my cell phone before leaving the house to go to work). After that, I never, ever picked up any voicemails or answered STD calls on days I was working until after the workday had ended. It was just too emotional for me and really useless for the most part as it really worked better for my doctor to communicate with STD and not me because (in my case) what they really wanted was stuff from my doctor, not me. And eventually my pdoc was able to word things or express things how they wanted and I would be approved.

It could be something quite simple though from your STD claims person. Maybe there's some piece of info missing from the original paperwork you filled out or they're having trouble getting in touch with your doctor or maybe they just have to touch base at certain stages in the claims process. Maybe they have your written paperwork but they also want to talk to you via phone about your condition. I truly have no idea and I wish I remembered more than that one phone call because I know I spoke to my STD case manager more than that one time and it didn't usually end in tears. But of course because that one call upset me so much, that's the one ingrained in my memory.

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Thanks aquarian--even upsetting calls are good to hear a lot about.  All I have else tomorrow is a doctor's appointment at 1:00.  So so long as our call happens between 10:00 and 12:00, I'm fine.  If ti doesn't, it could get complicated b/c I really don't want to reschedule w/ my GP.   But I can't keep waiting on the STD front. 

Hopefully it is something small or routine.  Fingers crossed, I guess.

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