By ANGUS McCAMANT
Several years ago I went through a serious health issue. My life got more complicated and I knew there would be some issues keeping my third class medical certificate.
Even after BasicMed was introduced in 2017, I continued maintaining a third class physical because I use an HMO (Health Maintenance Organization) and my physicians claimed they could not assume the liability associated with signing off on a BasicMed application.
These days, my physicals, both flight and normal checkups, are pretty boring, even after all my past problems.
I had no follow-up treatments other than imaging and tests, no prescription drugs, and no limitations on activities. I am able to maintain my normal routines, bike to my workplace daily, weight train, and enjoy occasional long bike rides (30-75 miles) with my son.
My health problem was rare, but is usually treated with little chance of future issues. From what I had read I did not see any problem maintaining my third class certificate.
I provided the requested information to the FAA and got a Special Issuance of a Medical Certificate and a request to continue to provide information on imaging and blood work.
I did not expect any problems. The FAA request was straightforward and simple. All that was asked was a general prognosis, medications prescribed, test results, and an in-person exam.
That is when things got frustrating.
My treating physician claimed he could not provide any documentation to the FAA.
I tried to explain that this was a simple request for treatment information — specifically the treatment they had provided — and was not a request for a flight physical. I showed him a copy of the BasicMed checklist and explained how the checklist was much different than my request. It didn’t help.
In fact, the situation escalated to the point that the head of the department providing treatment gave me a phone call and declared that they could not perform FAA physicals.
No one seemed to hear that I was not asking for an FAA physical.
This happened during the COVID pandemic. I was able to get all the information requested by the FAA except an in-person exam.
Knowing the FAA often rejects applications that are incomplete in any way — it clearly states this in the Special Issuance letter — I submitted video visit notes describing my condition and prayed.
For some reason that great bureaucracy showed a small sign of understanding and cleared me to fly for another year.
Of course, the next year I had to go through it again. I thought my regular general practitioner (GP) could provide the documentation, but he balked.
He said it clearly stated “treating physician” and said the specialist who provided the treatment needed to provide the information. But the specialist said he could not do so.
I ended up filing three complaints to the HMO, documenting all the correspondence, including the runaround between the physicians. After much discussion I was told that my GP would be able to provide the requested information.
My interpretation about what happened is that another pilot who is a patient in the HMO requested a BasicMed and was refused. At some point the request got to the legal department for clarification. The resounding response from the large HMO legal department was “we cannot allow that kind of liability.” It wasn’t just no, but hell no.
Almost certainly a memo went to all the staff physicians declaring they could not do FAA physicals. I expect the memo did not describe what BasicMed actually was and at least a few interpreted the memo to mean they cannot provide any information to the FAA.
At my last exam with my GP, I asked him how we could get the questions from the FAA addressed. The request was simple: “A detailed current status report from your treating physician. The report should address the stability of your condition, symptoms, treatment plan, current medications (name, dosage, frequency of use and side effects), and prognosis. Additionally, the report should assess if a cardiac evaluation is warranted.”
He pointed out that I have access to my records and could just use the appointment notes. I requested that he answer the questions in the notes, but he refused.
These questions could be answered with just a few sentences from my GP. I have no prescription medications, no symptoms or complications from treatment, my prognosis is straightforward, and I have no indications that justify further cardiac evaluation. My blood lipids, blood pressure, circulation, and overall health are all good.
At this point it appears my only viable option is finding another healthcare professional out of my HMO and pursuing BasicMed.
Because medical certification is one of the main reasons for people not being able to fly, I wanted to share my story.
Whenever changes are made to a system, such as the introduction of BasicMed, there are unintended consequences. New problems result.
I know that I am an unusual patient, however the HMO is large, and I am sure it will run into this problem again — perhaps by someone who has more clout than I do.
I hope that by sharing my story, fellow pilots will be aware of this unintended consequence — and that it could happen to them.
I also hope that by increasing awareness of this misunderstanding by the medical community changes can be made so that information can be sent to the FAA without a struggle.
The simplest answer is to go to a FAA AME and have him fill the form. He reminded me I did not have to see a FAA doc but he was familiar with the reluctance of a gp. $75 dollars later and I will see him again in four years. In my opinion any one that stays with a 3rd class with special issuance is just creating problems for them selves that is easily avoided.
The arm chair flyers at the local airport and FBO’s coffee table is a good source for such information.
Just another non-sensical result of our crazy, patchwork healthcare system. All my doctor friends who are in primary care hate their jobs and wish they’d pursued another career. It used be doctors were respected and allowed to actually practice medicine. Now they report to accountants and lawyers. Patient care is secondary to profits.
It is more accurately a reaction to our crazy, unlimited tort-liability system.
When any grieving relative can sue based on even the flimsiest of reasons & win because ‘the big company has lots of money and we the jury think they should give this poor lady some’…..
Then businesses (or government agencies) that otherwise wouldn’t care have to….
If you think Medicare or the government would be more sensible on this issue than private insurance is, sorry… No….
I had the same problem 5 years ago. I talked to aopa about it. They told me that physicians immediate care will do them. You need to make an appointment because they don’t have a MD on staff all the time.
Did it 5 years ago and a year ago in Rockford, IL and my buddy did it in Freeport, IL 6 months ago. $75-125. Problem solved
My primary care physician would not sign a basic med physical and would not even discuss why. I found another Doctor and provided a printed copy of the AOPA information on basic med. Her office called back and I am now a loyal patient. I think it is safer to work with my primary care physician that knows my medical status and performs regular checks than the occasional visits to an AME that seems more focused on FAA compliance. Keep looking. There are some good Doctors out there.
I ran into these same issues with my primary care physician telling me that “corporate” won’t let them do Basic Med evaluations due to the perceived liability. Funny thing is my AME works for the same exact medical group and does FAA physicals as well as Basic Med evaluations. “Corporate” must have given him the “lawyer-proof” lab coat…
Quite often being an AME is enough of a credential to make the liability folks OK….
Also at least around here AMEs that practice inside the major med groups tend to be ‘Occupational Medicine’ not GP or family practice…..
Just find a physician out of your HMO.
Additionally, should you be financially able to leave HMO and go PPO, you will be happier and not have the restrictions and general inconvenience of HMOs.
Understand that PPO doctors in my experience have been very supportive of Basic Med after I have explained the program to them. Upon seeing the form, they have said,” Sure. No problem. This is no different than my examining and signing off on a medical form for sports participation”. (Example–a young child that wants to participate in sports) Emphasizing that the form will be incorporated into your logbook and will go no further to the FAA nor other government agencies will put the physician at ease.
That being said, the PPO doctors will not submit the expense of the exam to your insurance provider which will make it out of pocket for you. Basic Med is considered beyond the scope of a normal well care exam and as a result is generally not covered by the insurance provider.
You need to get out of the HMO jail and go to a PPO.
Every year we are deluged with ads to “Sign up with our health care plan!!! We’re the BEST!!!!!”
Henceforth my first (and probably only) question will be “Do you do FAA BasicMed paperwork?” If the answer is yes, I want it in writing (and you can be darn sure you will hear from my attorney if you welsh on this), and if the answer is no, don’t EVER talk to me again, you’re stupid and useless and I flatly refuse to have anything further to do with you.
Possible solutions – 1) AOPA to educate doctors and HMO/PPOs as to what basic med is and that they have no liability, 2) Call it a “health status check” so all the doctor is saying is if you are healthy or not (which is what BasicMed is, but less scary sounding), 3) Find a doctor who is also a pilot – which can’t be THAT hard – and have them do the BasicMed for you.
Finally, we should generate a list of physicians and HMO/PPOs who will do BasicMed and a list of who will not. Post it on the AOPA website so we know not to get involved with the “no fly” list clowns.
Best Regards,
Miami Mike
I second Mike’s response!
An excellent suggestion, Mike.
Please correct me if I am wrong, but the Basic Med rule says an evaluation by “ any state licensed physician.” In many states, chiropractors are considered “ state licensed physicians.” They already do CDL physicals etc. I encountered resistance from my FAA AME to do a Basic Med evaluation. He claimed that Oklahoma City informed him during his examiner training that there was too much liability to do Basic Med. If that is true…the FAA is, in fact, undermining the Basic Med rules.
Using the same premise that these legal blood suckers have imposed on their HMO clients, this would seem to mean that any time a regular flight medical is obtained, that doctor is certifying that you will not under any circumstances have any medical problem until that certificate expires. This is a ridiculous premise and beyond the capability of medical ability such it exists today.
Because any such statement or sign off by a regular doc provides a minuscule increase in revenue, it is easy for lawyers to have their clients use such excuse for not providing any service. “Follow the money.”
I have a CDL-A and have to have a DOT physical every other year. The DOT allows NPs, PAs, and MDs to do these physicals, but they have to be registered with the DOT (don’t know all those particulars). It doesn’t matter if you have the Hazmat endorsement or not.
The people I go to would be willing to do a Basic Med if the FAA would accept them. But the FAA says MD at a minimum, as I understand it. Can’t be a Nurse Practicioner, or a Physicians Assistant.
So, NONE of the medical groups in the Indy area that I have talked to allow their MDs to do a Basic Med.
So I have to go to the AME that did my 3rd and 2nd class medicals to get Basic Med now.
Houston, I think we have a problem. Given the Basic Med requirements, the people doing DOT physicals should be able to do the Basic Med.
You need a new HMO, a new PCP, and we need to disband the FAA.
The FAA’s job is to keep people from dying in plane crashes. The best way to do that is to PREVENT people from flying. Never forget that.
Always remember the FAA motto. We are not happy, until you are not happy.