Detox/Rehab

[PatsGirl]

While this is a rather personal issue, I was hoping my DIS friends might be able to help out. I'll try to keep it short. We had an intervention for a family member two weeks ago and convinced him that detox/rehab was in order. It took some convincing but by the end of the "family meeting" he agreed to go voluntarily for a 28-day stay. Many hours of research were done picking a place that everyone in the family thought would suit him best. The major concern of his wife and my Mom was that there was specialized "chronic pain management" counseling as part of the rehab because we all agreed that without the tools to manage his pain he would go directly back into painkiller addiction. There is no local place so a facility was chosen in Virginia.

BC/BS has given false/erroneous information and has caused delays. Finally, they have said that his doctor needed to call them directly to "apply" for out-of-network coverage and a decision would be made either immediately or within 24 hours at which time admission must happen within 48 hours. Well, his doctor is refusing to refer him to this facility or any other one at this time. This is the same doctor who has been prescribing anywhere from 6-9 drugs at a time, from moderate painkillers to anti-anxiety to anti-depressants to combat the effects of the painkillers....

Anyways, I had a feeling that this doctor was going to downplay his addiction but don't know whether the patient is telling the whole truth and nothing but the truth... He has a great rapport with his doctor and has said all along that his doctor feels that, although he is taking too many meds, that it is something the two of them are working on and feels that outside intervention is not necessary. I think that we are going to be putting him in a body bag if he doesn't detox soon.

Does he have any other alternatives (other than paying oop) if his primary doctor refuses to do a referral? I think I have him convinced to pay the $8900 either way but as each hour passes his resolve weakens and I'm really afraid that we are losing his ability to go voluntarily. He is seeing the doctor again today (third time in the last two weeks) to speak with him again but he was so high yesterday that I know we are fighting against the tide here.

So my question is about insurance, does anyone have first-hand knowledge of the ins and outs of referrals?

 

[ilovejack02]

Oh my.. hugs to you and your family.

I really cant help you on specifics of all of this, but just a bit of FYI.
My best friend had major sx last yr.. pancreas half removed, gall bladder and spleen removed . He almost died and was in horrible pain for along time.
Long before the surgery he had been on painkillers because of constantly battling horrible pancreas issues.

Anyway.. once through rehab and off the painkillers for awhile. All pain disappeared. It was like his body was having phantom pain due to all the meds.
Maybe this will be the way it is for your family member also.
Hope it all works out for your family soon. You are correct it needs to happen very very soon.
We were prob just a week or two away from burying my friend.

 

[PatsGirl]

I've read about the phantom pain -- I'm so glad your friend was able to overcome his addiction and the pain.

From everything I've read, it's a toss up on the pain thing with chronic back pain or fibro or other debilitating and uncurable issues. Obviously, in this case no one (most of all the patient) has any idea what kind of pain he is really in but, unlike other addictions where you detox and you don't NEED the monster you are addicted to, if the chronic pain is bad enough, it's a much tougher cycle to break and may even be impossible to go med-free. There is, of course, methadone and suboxone but that's a whole other thread. This is what really, really scares him

When a person not yet mid-life is losing bladder control, can't drive because he can't sit up straight, and doesn't interact with the family because he knows we'll figure it out, it's time -- time to do something!

 

[RitaE]

It sounds to me like he needs a new Primary Care Physician. Either way, if this Doctor is feeding his addiction, that relationship needs to be terminated.

That said, getting referrals out of network when there are acceptable (note not the best, acceptable) alternatives in network is nearly impossible in my experience. Especially if he has not yet tried the in network facilities.

 

[ilovejack02]

I've read about the phantom pain -- I'm so glad your friend was able to overcome his addiction and the pain.

When a person not yet mid-life is losing bladder control, can't drive because he can't sit up straight, and doesn't interact with the family because he knows we'll figure it out, it's time -- time to do something!

We were at this point.. he actually saw the light himself a few weeks after his wife left him. It was rough and there were a couple of relapses but I think not being able to control ANY bodily functions really scared him .. thank God.

He now takes NOTHING for pain, broke his leg a few weeks ago and I just knew he was going to take the pain meds, But he didnt , I am so proud of him.

We really thought we would lose him several times, but through the grace of God he came around.

I will keep your family in my thoughts.

 

[Lisa_M]

Can he switch PCP's to get the referral? Do you have any family friends that are doctors that can give you some advice? My only other thought is that perhaps his wife can drop a hint that if he doesn't do what is in his patient's best interest, she will be persuing a malpractice suit for the doctor facilitating this addiction and not aiding in his recovery...I'm not a sue happy person, but if this was my husband, it would probably be my response.

Perhaps the Dr. is not referring because he is afraid if this man gets treatment, it will come out that he was overmedicating this patient. Such a shame...

I hope you all can get all this worked out. I guess if all else fails, get him in a closer facility and once they see that he needs chronic pain management counseling, maybe they can refer him to the other facility. Good luck

 

[PatsGirl]

You know, I think this was the breaking point for him as well. He actually told my Mom about it and I think it was a cry for help She is in such denial but this was a definate OMG point for her too.

RitaE: That's really bad news and exactly what I was afraid of. We'll wait and see but if he doesn't get approval for this particular place and decides that his detox isn't worth $10K, I'm not sure what we'll do. I've discussed this with the family and we're at a wait and see... the next day or two should tell.

I really hope it doesn't get to the point that I'll have to have him "sectioned" and sent to the local detox where they will do nothing to help him with his chronic pain. I think it will just become a vicious cycle that he will not be able to break if he isn't provided the tools...

 

[Pooh Girl 71]

Is he trying to use his medical insurance to pay for the SA treatment? Or is he using the mental health coverage? Most insurance policies have a separate company that manages the MH/SA stuff. Is he in therapy at all?

Do you have a local community services board? If so, he could always go for outpatient therapy there while he is awaiting approval for the inpatient tx. Also, the therapist at the CSB might be a good way to get him referred as well.

Do you mind me asking where in VA he is going? I work as a SA voc rehab counselor in Richmond.

 

[RitaE]

I'm not a medical expert by any means, but it sounds to me like his pain control needs are far beyond what a Primary Care Doctor can handle anyway.

At this point, I'd be looking for a Detox Clinic to handle the immediate addiction issues, and then a Pain Management Specialist to consult considering the chronic pain.

 

[mirmartinez]

Call the rehab and tell them the scenario. I am sure they have had similiar situations in the past with referral problems. They may be able to offer advice on how to proceed.

Also, maybe a quick visit with a mental health professional to see if he/she will give the referral.

 

[Poohlovr]

I have no advice on the rehab/insurance problem, but I would advise him to start going to AA meetings while he is waiting for that to be sorted out.

Yes, I realize his problem is not alcohol, but, the program can still help wiith other addictions and it may well help him while he waits for rehab.

We have a family member who was a herion addict. She has been in AA (And drug free) for almost 2 yrs. She said NA (Narcotics Anonymous) did not help her.

A family member can go with him for support to help him feel more comfortable until he feels he is able to go alone, if needed.

 

[JessicaR]

It sounds like he is in immediate need and care of a pain specialist.

http://www.webmd.com/pain-management/doctors-who-treat-pain

This would be the person that is best qualified to offer opinions on what is best for him. Don't be surprised if rehab isn't one of them.

You didn't mention the specifics of his pain but rehabbing someone with chronic pain may not be the answer.

This may be helpful.
http://www.castleconnolly.com/doctors/index.cfm

I wish him the best!

 

[Cindyluwho]

Call the rehab and tell them the scenario. I am sure they have had similiar situations in the past with referral problems. They may be able to offer advice on how to proceed.
.

Very good advice! The folks in the rehab facility should be very familiar with the ins and outs of medical insurance. If they are not willing to help with this and get some answers then it's time to check out a new rehab. That being said, it could be that he has told them that he does NOT want to enter rehab and they certainly don't want anyone who isn't ready, it's just a waste of time and money for everyone involved.

 

[arminnie]

I'm going to be very blunt here. His doctor is probably what is often referred to as a "legal pusher".

My best friend is on the medical board plus I have a good friend who is a licensed addiction specialist. The stories I have heard about some doctors!!!

Unfortunately there are a few doctor (tiny percentage of the total) who choose to make a fortune pushing drugs. It really is a huge problem. I'd never heard of it until a couple of years ago.

There's a time and place for the drugs that are out there - but they can be misused by the wrong physician. The biggest problem our medical board has is how to discipline them - they "lawyer up" really well and know how to skip around the boundaries of the law. The president of our medical board was literally blown up by a bomb last week - and it is almost certainly related to his efforts to get rid of these types of doctors.

Please get him to a new doctor immediately. This one is up to no good.

 

[mirmartinez]

We have a family member who was a herion addict. She has been in AA (And drug free) for almost 2 yrs. She said NA (Narcotics Anonymous) did not help her.
.

I know over 20 people and have met many many others who have 15+ yrs clean who work the NA program. My advice would be for the addict to pick the program that works best for them. Some people do both, the 12 steps are the same. Regardless, as the OPs relative will soon find out AA,NA, or CA are needed to stay clean.
I think 30 meetings in 30 days is a basic part of a treatment plan after leaving rehab.

 

[PatsGirl]

PoohGirl71: the name of the place is Life Center of Galax -- I did check out the credentials and have had an independent source give an opinion but I'd be glad to hear your opinions as well, although at this point, this is the only place he has agreed to go to voluntarily.

I have personally discussed the insurance/payment options with Life Center. They said they have had few problems having referrals okayed but cannot of course speak for the insurance company.

I too believe that this GP has possibly inadvertently become a pill pusher but I also believe that he has been misled. If it were only the prescribed pills that were a problem I'd be more adamant about pushing this doctor but the abuse is far beyond proper use of over-prescribed meds, it is now street drugs, selling/buying, crushing/snorting pills meant to be swallowed and eating topical meds so while he should be more aware of what is going on the deception is clear as well.

He will not go to NA nor will he go to any other type of outpatient rehab facilities. He is seeing a psychiatrist who seems to be a big help. This is a new endeavor for him and one that his primary suggested. They, the GP and psychiatrist are "treating his brain first, and then will work on his body" -- his words, not mine

I will look at the websites listed here and try to gain more knowledge -- I thought by now I would have had a phone call but nothing yet... I sit and wait and hope and pray that this doesn't turn into a battle ground. Brenda

 

[PatsGirl]

You know, I think this was the breaking point for him as well. He actually told my Mom about it and I think it was a cry for help She is in such denial but this was a definate OMG point for her too.

RitaE: That's really bad news and exactly what I was afraid of. We'll wait and see but if he doesn't get approval for this particular place and decides that his detox isn't worth $10K, I'm not sure what we'll do. I've discussed this with the family and we're at a wait and see... the next day or two should tell.

I really hope it doesn't get to the point that I'll have to have him "sectioned" and sent to the local detox where they will do nothing to help him with his chronic pain. I think it will just become a vicious cycle that he will not be able to break if he isn't provided the tools...

 

[PatsGirl]

Wow, not sure how this last post got repeated from an hour ago

 

[Pooh Girl 71]

He will not go to NA nor will he go to any other type of outpatient rehab facilities. He is seeing a psychiatrist who seems to be a big help. This is a new endeavor for him and one that his primary suggested. They, the GP and psychiatrist are "treating his brain first, and then will work on his body" -- his words, not mine

I will look at the websites listed here and try to gain more knowledge -- I thought by now I would have had a phone call but nothing yet... I sit and wait and hope and pray that this doesn't turn into a battle ground. Brenda

Galax is out of this area. I will see what I can find out about them if you'd like.

Well I can tell you from working with the SA population is that you can detox anyone and get the chemical addiction out of their system. That's the easy part. Unless you get to the root of the problem and address whatever the psychological need for the substance (and this applies to ANY addiction ie: shopping, gambling, eating, sex, whatever) they will continue to go back to that addictive personality.

And I know you probably don't want to hear this, but unless the person really wants to get clean and stay clean, it's not going to happen. Most people usually need to hit rock bottom to realize they need and want help.

I also think AA/NA are a great resource for anyone dealing with an addiction or a family member/friend with an addiction.

 

[PatsGirl]

Just an update for those interested and were helpful last night -- good news The insurance BC/BS has come through and we are now fine-tuning his trip. I'm looking into airfare, etc. and he is trying to find out if the admission can wait until Monday (rather than Saturday, the 48 hour limit) when airfare is less than 1/2 what it is the next three days (155 vs. 389 but worse, no non-stops and he is deathly afraid of flying ). He sounded excited to finally have a plan in place. I did not get a chance to talk to him about his doctor visit and how he managed to convince his doctor to refer him but right now that doesn't matter, it happened. Keep your fingers crossed that all goes smoothly from now until take-off and let the next chapter begin.