Please help: MetLife is not going to approve my short term disab.

Discussion in 'Fibromyalgia Main Forum' started by auntyemnga, Mar 26, 2006.

  1. auntyemnga

    auntyemnga New Member

    Hi all,

    My doctor e-mailed me Friday night to advise me he had a phone call that afternoon with the medical director of MetLife who my short term disability insurance is with.

    She (the MetLife medical director) ultimately said that there's no proof that Bioresonance Testing works and no proof that mercury can cause any of my symptoms as well as indirectly threatening my doctor with an investigation into his medical license. The bottom line is that my disability is not going to be extended.

    Once MetLife calls me tomorrow to advise me of their decision I will then need to appeal their decision. I have a thread called Field Control Therapy that you can read to see what my doctor (internal medicine & accupuncturist) has been doing for me.

    I am open to any and all suggestions that I need to take to help me win the appeal.

    Thanks for your help,
    Auntyem[This Message was Edited on 03/26/2006]
  2. Jen102

    Jen102 New Member

    YOu are going to need hard medical evidence to prove up your disability case. You will need a diagnosis and evidence of how it renders you disabled from working. You will need to show that you are under the care of a physician.

    Also, some other things to watch for are provisions in your policy that limit benefits to two years for illnesses which result from mental disorders (they well know that FMS and CFS are real medical illnesses, but these are dirty dogs who will try to show it is all in your head to save the almighty dollar), or for self-described illnesses. If you don't have a copy of your policy, GET ONE, and read it, or have an attorney read it.

    Has your doctor provided a letter that shows your diagnosis, including all of the elements of the illness? So for CFS, can't remember them all, but the CDC website has them--fatigue lasting longer than 6 months, swollen lymph nodes, etc., etc. This shows the diagnosis. As many diagnoses as you have, you should supply to the insurance company. If you have a diagnosis of RA, for example, it has hard numbers, such as a SED rate. If FMS, you could have blood tests of hormone levels (thyroid, sex hormones, cortisol). While these may not be wildly out of range, a case can be made that your situation taken as a whole indicates problems.

    Then comes proving your inability to work. Your doctor will need to document your limitations. In particular, he should document the duration, severity, and (one more, can't think of it) of your symptoms. In other words, just cause you can do something for 10 minutes at your best moment (like I am writing to you) doesn't mean you could do it for 8 hours a day, 5 days in a row. Your doctor will need to be specific. You have trouble communitcating with people (like a supervisor or customer) because you can't process language, you can't sit more than 2 hours without lying down, you would likely miss 2 days out of five, the pain meds you are on make you unable to do simple math, etc. If your doc can't do this, ask him who can.

    You are in a bit of a quandry because you are taking an alternative path. The insurance co and your doc don't talk the same language, they think he's a quack, and they are likely to disapprove you because they think they can get away with it. Will your doctor help you play their game and support your case? Wouldn't you benefit from various medical testing and therapies? For example, maybe a sleep test isn't warranted, but have you tried different sleep meds and can report success or problems? Would these help you, or doesn't your doc believe in them? If he doesn't you may be faced with a decision to see a more conventional doc, or forego benefits. A difficult choice. Maybe you could play the insurance game for now, and go back to your doc later when things are more settled.

    Just a few ideas off the top of my head. I wish you the best. Jen102
  3. auntyemnga

    auntyemnga New Member

    Thanks for responding. I had been telling my PCP, oncologist & endroconologist for over 6 years that I was always fatigued but no one was interested in doing further testing other than the normal blood work.

    I started going to the FFC in Oct 05 thinking that was the answer to my prayers. It wasn't due to the doctor putting me on hormones that totally screwed me up. That's why I started going to this doctor because I believed in what he was doing.

    MetLife has my documentation from the FFC. My problem is with this doctor he doesn't need to do any testing other than his bioresonance testing. If I have mri's or x-rays done, he then has to treat me to remove the x-ray residules.

    It sounds like MetLife doesn't want to approve me any longer because they don't believe in my doctor's treatment. The way I see it mainstream medicine didn't help me so now I don't know where to turn.

    I'm gonna sit down tomorrow and start making a timeline of my illness.

    Thanks,
    Auntyem
  4. Jen102

    Jen102 New Member

    can you find an attorney to help you? It is likely that you will need to do so in order to get benefits. They can help analyze your case and see if you have the proper evidence in your medical records. The insurance co knows how sick you are and they will stonewall till you go away unless you bring out the big guns.

    What did the FFC say? Would they have supported you and provided the necessary documentation to help you support a disability case? If so, could you work with them along with your present doc for a time. Maybe limit what you take from the FFC recommendations which directly conflict with your other doc.

    Have you gotten a full copy of your FFC records to know what's in them? Maybe that is a place to start--getting med records from everyone. Check them carefully. When I asked for my records from my PCP for 15 years, I got about 1/4 inch. They copied 2 of four sections, and only the front sides of the pages. Of course I lacked adequate proof based on those records--they didn't even make sense when only the front pages were copied.

    Have you a copy of the policy? Good to get and read.

    You don't need to have MRI's or X-rays or a sleep study to prove disability--these aren't necessary to prove FMS or IBS. The insurance company is just trying to put up a smoke screen. But drawing blood shouldn't affect what your doc is doing. But if you went to FFC, all of this was likely already done. What did it show? What were their diagnoses and how did they support them?

    Blessings to you. Let us know how it comes out. Jen102
  5. auntyemnga

    auntyemnga New Member

    Jen,

    Do you think I need to get an attorney for short term disability?

    The FFC is who originally put me on disability. I need to call them tomorrow to see what all they had sent MetLife. I'll also ask them to send me a release form that I can sign so they'll send everything to my current doctor.

    I have a booklet about short term disability and with my brain it's hard to decipher all of the gobble-do-gook. All I know right now is I can appeal.

    MetLife sent some questions and comments to my doctor about 6 weeks ago. It went something like this: there is no record the employee is seeing a mental health professional (which I am), if employee has insomnia why hasn't a sleep study be done (Oxi-scan was normal so ins. wouldn't approve sleep study), why can't employee work at a sedentary job (duh!!), and last but not least... the mainstream medical treatment for FM is anti-depressants and exercise. This lady has no clue!!!

    FFC did blood work on 26 vials of blood. I'll ask tomorrow is they sent that to MetLife. FFC diagnosed CFS and FM with adrenal dysfunction, candida yeast, thyroid problems and a few other things that I don't remember right now. MetLife really didn't understand the FFC either.

    Auntyem
  6. springrose22

    springrose22 New Member

    I believe that most insurance companies are interested in the fact that you are disabled, not necessarily in your diagnosis, although they go hand in hand. Once you have a copy of the insurance policy, then you will know how to handle this. An internist is actually a fairly "normal" doctor, but with more education. I am amazed that the insurance company would speak to him and 'threaten' like that!!! I would like to see class action lawsuits started against many insurance companies. Many of them seem to use very shady tactics in order to get out of paying...Marie
  7. zena01

    zena01 New Member

    Hi, the first thing I'd do is hire a disability attorney. You don't know now, that this short term disability will not end up being long term. You need to win the short term now, because if you end up not being able to go back to work, you wouldn't be able to go after long term.

    They should be sending you a letter about their denial. If they do call, ask them for it in writing. (you don't want to be told an appeal by date then when you appeal find out you missed it because it was different. You need the denial and reasons in writing anyway to send copies to your attorney. They should give you plenty of time to find a disability attorney -- disability cases are difficult, and I think you need an attorney that deals with it all the time who knows what wins and doesn't to help you. They will let you know what they need to win and you can get it for them.

    I am currently dealing with Prudential for the same thing. I stopped working in April 2005, they denied my short term August 1st 2005. My appeal will be filed 4/24/06. Their reason for denial was "physical exams in file do not show a loss of function." and "based on her doctors and her report of home computer use to research her medications and medical conditions on various websites it is reasonable to assume that she has intact cognitive ability."

    I have 2 rheumatologists, 2 neurologists, and my regular Dr. who I have seen for 12 years saying that I have Fibromyalgia and that I cannot work but that doesn’t matter. I have an illness that cannot be proved.

    As someone said you do need to ask for a copy of your policy so that you and your attorney can go over it. Disability companies try to turn it into a "mental Illness" as most have clauses they only pay mental for 2 years. Also, there is a 1 year stipulation in my own policy for self reported illnesses. Fibromyalgia is so difficult with the insurers -- they don't want to pay and it is so difficult to prove. My attorney told me to get cognitive testing. If I can prove that then it is no longer self reported and if we can get them to pay, we’ll go from short term right into long term as it has been that long.

    It is difficult to find a Dr. that does testing, then one willing to after they know you have a claim. I am lucky I found a really neat guy that listened when I told him that fibro people come up normal on a lot of the tests that are done and talked to me about it. He said he did notice several different problems I had during the interview portion and that he has two tests he thinks will show it. If not, he said he'd figure something else out.

    I was happy when I left because here is some proof! Everything else there is no proof! But then I realized yeah, you’ve known you have cognitive problems but now they are really there and people can see them. I am even more self conscious talking to people now knowing they notice. My mom tried to make me feel better by saying only people that know you well or people that are trained to notice would.... :)

    Anyway, Auntyem, please get an attorney and let them do your fighting for you – you concentrate on feeling better, and giving them what they need to win your case. You also might check and see if MetLife is one that already has a class action suit against them.

    Good Luck!!

    Sherri
  8. auntyemnga

    auntyemnga New Member

    Sherri, Marie & Jen,

    Thanks for the advice! MetLife did not call me today as I thought they would. I guess they'll probably send me something in the mail.

    How do I go about finding an attorney?

    Auntyem
  9. FoggyDayz

    FoggyDayz New Member

    I am going through a battle with metlife also right now. I have been out on STD since Jan. 13th, they approved me up until March 5th and then denied anything after that. I am appealing that decision; I have not gone back to work yet.

    I just requested a copy of all of my medical records and am making appointments with a rheumatologist and a neurologist both. Then I plan to get an attorney because I really don't see how I can go back to work and function for any length of time.

    Good luck and I will share any successes failures I have during my battles as well.

    Hugs!
    FoggyDayz
  10. auntyemnga

    auntyemnga New Member

    Thank you so much for your response. It's nice to know I'm not the only one having trouble with MetLife.

    According to my case manager I was the first person to have CFS and/or FM. I told him that sounded very strange (considering MetLife is a pretty big company).

    MetLife still hasn't called me today to let me know they're not going to continue my STD.

    Did you just not report to work or how did you go about telling them you weren't going back? This all scares the bedazzles out of me.

    By any chance to work for a telecommunications company? You don't have to answer if you don't want to.

    Yes, by all means, please keep me posted!! I am feeling all alone in this battle but knowing you are out there makes me feel not as alone.

    Thanks,
    Auntyem
  11. judyntx

    judyntx New Member

    Hi auntyem! I am new here but I just had to reply because when I first got sick it was so hard to prove. I was lucky and legal aid took my case.So it didnt cost me anything.If there is a legal aid service in your area check them first.If that dont work there are lawyers in or near just about anny town that do almost nothing but disablity cases and will not charge you anything untill they win your case.So if they take your case and most of them will,then they will want to make sure you win so that they get paid.You can just check your local phone book or ask around for lawyers that specilize in disablity cases. I was with blue sheild blue cross at the time.This was 10 yrs ago when it was even harder to prove.They didnt give me a hard time.It was when I had to go for long term and S.S.D. got involved.At that time the C.D.C. did not even believe C.F.I.S. was a real illness.Another thing that helped was my job was on my side and wrote letters for me. I had been fighting to work for so long,they had seen me as I got sicker and sicker.My boss said she could tell I was sick but was just waiting for me to say something.One last thing that helped.well two, I kept documented EVERY thing I could and went to the Dr. even if I was just running a low grade fever,stomach pains,headachs ect.It was a pain going to the Dr. so much but this way I had proven documantation of everything and in the end that won my case. I was told at my hearing that they didnt believe I had C.F.I.D. but I was being granted my disablity anyway because I proved that with all the different symtoms of some kind of illness I had, there was no way I could win.I won because I was so tiried I would fall asleep on the job,I would often get sick and throwing up and get sent home,and my doctor records proved I was running a fever so often and was in constant pain.That I had short term memory loss ect ect.So I won on the symptoms not the illnes.They also proved stress could put me in bed for one to several days.This means the strss the insurance company is putting you under is making you worse and when all is said and done if this is true in your case then you may have a law suit against them.It is so.o..o hard to get thru all the paper work when you are sick so this is another reason you really need help.I hope you get some good news soon. God bless you...judyntx
  12. FoggyDayz

    FoggyDayz New Member

    I am supposed to go back to work on Monday, April 3rd per the note from my doctor. I have told my work that I have a doctor's appt. on Monday April 3rd and that I will give them a call that afternoon.

    I am a manager so I really don't think telecommuting would be an option. If they want to give me a different position that allowed me to telecommute I would probably take it.

    I haven't figured out how I'm going to tell my work yet - I need to figure out how things would work with disability, insurance, etc.

    Glad you're out there too! :)
    FoggyDayz
  13. skierchik

    skierchik New Member

    Sorry I don't know anything about STD, but I'm here to support you any other way I can.

    Hope this comes out right for you. You're getting some great advice.

    Hugs,

    skierchik
  14. auntyemnga

    auntyemnga New Member

    Foggy,

    How did your appointment go on Monday?

    Skierchik,

    Thanks, I can always count on you!

    Auntyem
  15. auntyemnga

    auntyemnga New Member

    I finally called my EAP last Wednesday. At first they said they couldn't help me because I was already seeing a counselor. The more I told of my story I guess the more the EAP agent felt sorry for me. I was near tears!!

    He spoke to his supervisor who told him about a new Life Solutions Outreach program with UBH. He stayed on the line until he found a 'live' person for me to talk with. By then I was in tears and thanking him profusely!!

    The next agent opened a case and told me Ms X would call me back. Well, we played telephone tag Thursday and finally spoke to each other on Friday. I told her I was at the point where I didn't even want to talk with MetLife. She faxed me a release form to sign so she would be able to talk on my behalf. She was sympathetic and said all the right things.

    After I sent back the signed release, Ms X conferenced on the MetLife nurse (the one who was suppose to call me the Monday before) but we got her voice mail. I left a message saying that Ms X was on the line with me and that I was calling to get an update since she said she would call me the Monday before.

    Well, it is now the end of Tuesday and I haven't heard from MetLife or the UBH Life Solution Outreach agent. I guess they're both hoping I just fall off the face of the earth : ( Not really, but it doesn't give me a warm & fuzzy feeling.

    I'll call the UBH Life Solutions Ms X tomorrow to see what is going on.

    Thanks for listening,
    Auntyem
  16. auntyemnga

    auntyemnga New Member

    The MetLife case worker just called me to tell me I would need to go back to work tomorrow as they were not approving any more time. If I wanted to know the details, he would transfer me to the nurse.

    I told him I wouldn't talk any further with him until I had my UBH rep on the line with us. He then asked if I was seeing another provider. I told him a mental health counselor and a physciatrist. He asked when the appts were and I told him. But I also told him I wouldn't talk to him anymore until I had UBH on the line.

    He put me on hold to ask his supv if he could do that. He came back and said the supv was not available and asked if he could call me back this afternoon and I said yes.

    I called UBH this morning at 9:00am and have not heard back from the rep. As soon as I hung up from MetLife I called her again and left another voice message.

    I can't take this stress anymore!!!!

    Auntyem
  17. skierchik

    skierchik New Member


    I don't know anything about disability and can't give you advice. But know, that I'm think of you and will send positive thoughts your way. Hang in there!!

    Hugs and kisses to you.

    skierchik
  18. yuckie

    yuckie New Member

    I almost wasn't going to respond because I didn't want to relive my horrible experience with MetLife. Long story short, I went out on short term disability in February of 2005. They paid until June and then no more until I hired an attorney. In January of this year he won back pay on my short term and long term disability and social security. Before I hired my attorney they harrassed me, ignored me, disrepected me and talked down to me. I went through EAP with no results. When I hired my attorney he told me not to talk to them or SSA. What a relief! I needed to focus on my health, not fighting them! Anyway, after compiling a 2 inch stack of documentation from doctors, therapist, experts, friends and family, the attorney won my case. MetLife began paying monthly in March 2006. The same week I received their first payment I also got a letter from them telling me that they were reviewing my case and requesting information from my doctors to confirm I was still sick. It never ends!!!!

    My suggestion, get an attorney and quit talking to them immediately. Those conversations will only make you sicker. Take care.
  19. auntyemnga

    auntyemnga New Member

    Thank you both for your advise. I guess the first thing on my list for tomorrow morning is find an attorney.

    Update on my 2nd call call with MetLife. The nurse called me. I asked to get the UBH rep on the line and she said she was not allowed to talk with anyone but me. I said ok (like what choice did I have!) and the only details she could give me is that the medical director said there wasn't anything stating that FCT works. I asked if they called Dr. Yurkovsky and she said they thought of it but they didn't call him. He's the doctor who created, designed, uses and teaches about FCT (Field Control Therapy).

    I told her I didn't like sticking her in the middle of this so she said she would ask the case manager to call me. The case manager called me. He told me he couldn't add the UBH rep on the line. I asked if I could and he said yes. I then conferenced UBH on the line.

    I'm glad she was on the line cause by then I was crying and trying to take notes and pay attention and not having much luck. There's too much detail and I'm exhausted both physically and mentally. I'll try to update tomorrow.

    I'm not physically able to go to work so I'll take vacation time for now.

    Auntyem
  20. yuckie

    yuckie New Member

    Please go to the disability tab on this website and consider using Scott Davis. He is very good.

    I know how exhausting this fight can be. You need an advocate. Take care.