There is one thing which is important to understand when it comes to insurance companies: money is what the point is. It doesn’t matter if it’s CPS or any of the other myriad of health insurance companies out there. They are there to make money.

So for them, disability is a very bad thing. (For the sick, it is a very good thing.)

What this means in English is that in all likelihood they will push you to get off of disability sooner than you are ready, just like they will try and force you to get off of non-generic drugs. Those are more expensive. So what they will do is come up with most any reason they can to take you off of disability. A slightly positive comment from your therapist or doctor. You saying in a phone interview “I really think I could work some”. They will glom on to anything possible.

I write this not to denigrate our healthcare system. The LCMS has one of the best healthcare programs in the country. I shudder to think of the hoops one might have to jump through with some of these others.

So in understanding these things, you need to know your rights. Here are at least some of them as I have come to understand it:

1. You have the right to be sick. They can’t make you better on a piece of paper. Mental illness is real, painful, and debilitating. They cannot pretend this isn’t an illness.
2. Your doctors and you determine when you need to go on disability, not them. Certainly there are requirements, etc, etc, etc. But the bottom line is that if your doctors say you are not ready to go back to work, then you’re not ready, and no “peer review” can trump an actual doctor’s professional opinion.
3. Your goal is to get better, not to freeload off of “the system”. This may be obvious to you, but part of the reason why health care companies are so skittish about disability is it’s abuse. If you make it clear to them that you want to get back to work, that will be one of the things they want to hear.
4. Disability is intended for healing, not heartache. Every time they make it more difficult for you to stay on disability, they are probably prolonging your sickness. This needs to be repeated to them over and over again. It is costing them money, they will be legally liable with any problems, and the like.
5. God is merciful, and he will take care of you. Ok, that’s not a “right”, but it is a gift given to you in the waters of Holy Baptism. You may confidently trust that our Lord will take care of you through thick and thin, as he best sees fit.

So what am I missing, friends?

-DMR

There is one thing which is important to understand when it comes to insurance companies: money is what the point is. It doesn’t matter if it’s CPS or any of the other myriad of health insurance companies out there. They are there to make money.

So for them, disability is a very bad thing. (For the sick, it is a very good thing.)

What this means in English is that in all likelihood they will push you to get off of disability sooner than you are ready, just like they will try and force you to get off of non-generic drugs. Those are more expensive. So what they will do is come up with most any reason they can to take you off of disability. A slightly positive comment from your therapist or doctor. You saying in a phone interview “I really think I could work some”. They will glom on to anything possible.

I write this not to denigrate our healthcare system. The LCMS has one of the best healthcare programs in the country. I shudder to think of the hoops one might have to jump through with some of these others.

So in understanding these things, you need to know your rights. Here are at least some of them as I have come to understand it:

1. You have the right to be sick. They can’t make you better on a piece of paper. Mental illness is real, painful, and debilitating. They cannot pretend this isn’t an illness.
2. Your doctors and you determine when you need to go on disability, not them. Certainly there are requirements, etc, etc, etc. But the bottom line is that if your doctors say you are not ready to go back to work, then you’re not ready, and no “peer review” can trump an actual doctor’s professional opinion.
3. Your goal is to get better, not to freeload off of “the system”. This may be obvious to you, but part of the reason why health care companies are so skittish about disability is it’s abuse. If you make it clear to them that you want to get back to work, that will be one of the things they want to hear.
4. Disability is intended for healing, not heartache. Every time they make it more difficult for you to stay on disability, they are probably prolonging your sickness. This needs to be repeated to them over and over again. It is costing them money, they will be legally liable with any problems, and the like.
5. God is merciful, and he will take care of you. Ok, that’s not a “right”, but it is a gift given to you in the waters of Holy Baptism. You may confidently trust that our Lord will take care of you through thick and thin, as he best sees fit.

So what am I missing, friends?

-DMR

This is I think one of the hardest decisions when you suffer from depression. There are lots of reasons you dont want to talk about it: You’re ashamed, think you’re weak, don’t want to let others in, don’t want to receive “the look,” and a thousand others.

I guess that for the pastor (and really for most people), there are two layers of this question. If you are simply taking medication and therapy, you can probably keep the circle of people “in-the-know” fairly small. I’ve known a number of pastors who never told anyone in the congregation through the entire process. The advantage to this is that your illness won’t have a potentially detrimental effect on receiving calls, etc. In the business world, pretty much everyone will tell you never let anyone know you’re taking anti-depressants. I find this truly a sad commentary on our culture. For a culture that talks so much about being inclusive and receptive of people with “differing abilities”, mental illness is the exception. I have found that this is often true in the church. I would never begrudge a pastor who chose not to speak with his congregation about a mental illness.

Disability, however, is a different matter. If you apply for disability, then it is really impossible not to speak with your congregation about the matter. Your circuit counselor, with your input, will have to find someone to fill in for you while you are on disability, and someone, maybe several someones, will need to come into your parish to give them a little catechesis on mental illness and depression.

This is hard. I admit it. It is admitting what will be viewed by many as a weakness or even as a failure. You’re depressed because you aren’t strong enough to make yourself better (tell that to someone with a heart condition). No one likes that level of self-disclosure, least of all super-pastors. It’s a lesson in humility that is a good one, but painful at the time.

Yet in this disclosure lies freedom. It frees you to recognize your own illness. You don’t have to hide and pretend and act and do a show for everyone. You can actually be sick. Recognizing your sickness is the first step to healing. Sharing your sickness allows others to bear your burden with you. I think that’s in the Bible somewhere. Look it up. It is through our weakensses and trials that Christ is at work, showing the world His own suffering for us.

For myself, telling my congregation has been the best thing for my ministry since I was ordained. I won’t say that it has been picture perfect, that everyone has embraced us, or any kind of fairy tale ending. It has taught me (and my family) to look to Christ for strength, and not to ourselves, or even finally to my parish. My parish has taken care of me with generosity beyond expectation, and despite the bumps along the road, it has been a blessing for all of us.

I know it does not always work out this way. I know of pastors who have been forced to resign, undergo enforced psychological evaluation by their district, or worse. It’s sad, but true. Having said that, being straightforward and honest is always the best thing to do. That doesn’t mean make your whole life and psyche an open book. It does mean, however, not pretending or acting as if nothing is wrong when there is.

Christ is merciful. He will take care of you. Be at peace and bask in the glow of our Lord’s incarnation for you.

-DMR

Here is the short and sweet version of what short term disability means and how it works.

The first step to get on disability is to call the mental health services number on the back of your Concordia Plan Services healthcare card. It is CIGNA Behavioral Health. These are the people that give you prior authorization to see a psychiatrist or a psychologist On my card the number is 1-866-726-5267.

One of the big questions is: who determines whether you are disabled? A good question. You actually make the call to apply for disability, but it is your doctors that recommend you for disability. Finally, there is supposed to be a group of doctors who impartially determine whether you qualify for short term disability. They have two weeks to make that determination. It is helpful in this process (and they’ll give you all the addresses, etc…) to have numerous witnesses lined up. These should include as many of the following as possible:

• Physician
• Psychiatrist
• Psychologist/Counselor
• Circuit Counselor or some other district rep
• Spouse
• Congregational President and/or Head Elder
• Anyone else who can speak intelligently as to your medical condition.

This obviously requires more organizing that I wish. Frankly, it’s asking a lot at the exact time when you may have no energy or mental ability to handle it. You need someone to help you with this. It may be your spouse. It may be your counselor. It may be your circuit counselor. But someone else needs to help you get through it. That will bring us to our next topic: who do you tell and why?

Be at peace, friends. Our Lord is coming soon to release us from the bonds of sin and darkness which so beset us.

-DMR

Ok ok okay! I’ll try and write something up on disability and mental health.

I have been on and off disability for some time. I’ve gone through one appeal process with CPS, and I am in the process of working on another appeal. So in so far as the uninitiated can understand the disability process, this is how it works:

Before my first of all, I will say that those suffering from depression or other mental illnesses are at a real disadvantage with the “system”. The system is about paperwork, deadlines, phone calls, organization, and keeping on top of things. Shoot me now. These are all things that most people suffering from depression can’t handle from the beginning. So if there is a way to get an advocate to help you with paperwork and staying on top of things, that is HUGE. I can’t overemphasize how important that is. It could be a spouse, friend, nurse or social worker from church, circuit counselor, or someone else. The bottom line is that they A) Need to be able to help you stay on top of this and B) Someone that you trust.

So having said that, first of all, there are a couple magical organizations which must be known and understood in order to make sense of the whole thing. Mileage may vary depending on where you are in the country. I would be interested in knowing how this process differs. I THINK this is the same for anyone on Concordia Plans Services.

The first step in get a doctor or therapist assigned is calling CIGNA Behavioral Health. 1-866-726-5267. You may also find them at CIGNA. You call that number and get pre-authorization for seeing a psychiatrist or psychologist. I think you could do this through your general practitioner, who could proscribe medications, but trust me, you need to get specialists.

Once you have found a doctor and/or therapist (I recommend both), they will need to determine whether you are physically and mentally capable of serving as a pastor at this time. I’m sure medication will be tried first, but it may not be for long. I was on medication for less than a month before I applied for full-time disability.

After your doctor(s) have urged you to apply for full-time disability, you call that CIGNA number again and say you are applying for full-time disability. They have two weeks to make a determination on whether to grant the disability application. They will ask for your permission for your doctors to share their info, your congregational president to write a letter indicating that you are no longer working, and may give you the opportunity to ask people to provide supporting letters (like your circuit counselor, spouse, etc).

So you will know within two weeks. Your disability payments will begin starting at the end of that two week period. Then every month they usually ask for some sort of update on your status, badger your doctors to get you back to work, and the like. You’ll have monthly phone calls at least, and (at least at the beginning as I recall) monthly paperwork.

One thing that is important. Make sure your congregational president writes that you are doing no work for the congregation whatsoever. If you are volunteering your services in some limited capacity, that’s between you and the congregation. But they can’t PAY you ANYTHING while you are on disability. We’ll discuss finances in a different post.

At that point you will also be shuffled over to another organization. AETNA. You will be assigned a case manager, and they will “take care of you” while you are on disability. When I began my disability journey, the company in use was Broadspire. But now I believe they are switched over to AETNA.

IMPORTANT NOTE: It doesn’t matter whether this is you or someone else, but someone must keep a journal of everything. Dates of phone calls, letters, critical events in your health, etc etc. It stinks. I know. But it just needs to be done. If you have a good therapist, they can help recreate this stuff. But don’t bank on that. Try to find someone who can help you.

So that’s the beginning of the process. Questions? I’m really not trying to paint this as a negative picture. I’m trying to be honest and straightforward on how it has worked in my experience.

I know this sounds scary and overwhelming. Believe me I know. Calling to apply for disability was one of the most difficult things I’ve ever done in my life. But God is merciful, and despite the quirks and turns in our system, they will take care of you. You are in His hands, and he won’t let you slip into the darkness forever.

-DMR

I’ve had people asking me for some time to talk about disability and the LCMS insurance system. I have hesitated to do so, because I want to focus on health and healing and God’s forgiveness in Christ. I don’t want this blog to serve as a place to, um, complain about troubles and trials in our system. I’m not going to do this.

But I have been convinced that it would be helpful to talk about the LCMS insurance and disability plans, and how it actually works for pastors, church workers, and their families as they struggle with mental illness.

So that’s what we’re going to talk about this week.

What questions do you have?

-DMR