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MRI was completed during a recent Hospital stay... partly by request of my mother. Stubbornness along with denial, as well as, poor cognitive insight related to atrophy of the brain is preventing my dad from seeking medical assistance from a neurologist. My mom and I need to attend a consult with a neurologist to know what to expect and to get a more specific diagnosis. Are we able to do that without my dad's presence?

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Is something like this authorized in the health care Living Will/Health Care POA? I would think it would be a condition precedent to making decisions, which is in fact the purpose of the POA.

You have to be informed to make decisions, so I think attending the appointment, even w/o your father present, is justified. Just be sure to check the authorizing language.

If you think the neurologist might not agree, take a copy of the authorizing document with you for the appointment. You probably should also explain that your father's position is not conducive to making decisions that might have to be made, and your presence and decision making capacity facilitates getting the care he needs, so it's part of his "continuing care" requirements.
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I will have my Mother double check the POA documents for specifics. Unfortunately, the reason why I posted this question, was because of the doctor's office response ("we need to see the patient"). Of course my Mother explained the situation, which in my opinion can not be unheard of, based on the very common s/s of most dementias...impaired cognitive insight and the unawareness of one's own deficits!! Thank you for your response, any advice is extremely welcomed!
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Jess, were you told that they "need to see the patient" by a nonmedical staffer, or a nurse, office manager, or the doctor him/herself?

I've found that doctors are much more approachable these days, and I've been able to get them to return my calls to discuss specific issues. You might try leaving a message for the doctor, or even dropping off a letter explaining the circumstances.

Staff members probably aren't authorized to make these kinds of decisions, but doctors are.

Another option is to go with your father; his "stubbornness" and "denial" may make it very clear why you and your mother need to be involved!
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It was an office staff member at the desk that relayed this to my Mom, however, due to the emotional heart felt plea coming from my Mom, she was told someone else from the office would be contacting her...I agree w/ your statement about contacting medical professionals directly and with other doctors (oncologist...etc.. ) a rapport has been established and both my parents call the NP or Doc directly, however, this is a new doctor. My Mom is very determined and will utilize all of her resources!! After you have jumped through the medical hoops for years, it can just be frustrating and exhausting... I thought I would reach out and see who else may have boarded this boat!! Thank you so very much for all of your help!! She just now has contacted their attorney for clarification and advice, so she can move forward fully versed on her rights as POA. Thank you again!
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If your mom is willing to pay for the doctor's time then there is no problem. But you can't expect his insurance to pay for an appointment that he doesn't attend! This is what the doctor's office is talking about. What's the first thing you do when you go to the doctor's? Show your insurance cards and pay your copay if you have one.

So perhaps emphasize to the staff that you are willing to pay for the office visit up front and you might be able to get what you want.
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Your mother also needs a signed HIPAA document in order to be able to access medical records or discuss health care without the patient present. If they don't have authorization to talk with your mother or you included either at doctor's office or in POA paperwork, the doctor's office can get in a LOT of trouble if they discuss info without patient present.
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Jess, "way to go!" and congratulations to your mother for her determination!

Nomad, you raise an interesting issue, one about which I know nothing as I always accompanied my father on appointments. However, we've never been billed for telephone conversations when I've called PAs or spoke to doctors outside of the office.

Jess, just another thought. If the MRI was done at a hospital, there would be a report on it by whoever interpreted it. The neuro doctor would explain in understandable language. And, assuming he/she has access to hospital records (as do physicians here) if he/she practices at that hospital, then the interpretive report would be available through hospital records.

You could request that from that medical records department at the hospital.

That's what I've done. Then I could research all the terms I didn't understand and ask the follow-up doctor to explain the significance.
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GSA, good point. I had forgotten about that.
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I actually did encounter this situation with my mom. She was in a geri-psych facility and had a doctor's appointment scheduled. I called to let them know she was in the facility but that I wanted to keep the appointment and speak with the doctor. I had hcpoa at the time (now guardian) and had been with her to all appointments. But I was told, not without the patient because otherwise, if they bill insurance and don't see the patient it is insurance fraud. Since I couldn't afford to pay for the visit myself, that was that.

Now that said, I have found that specialists tend to be more willing to converse on the phone if you are hippa approved. My mom's cardiologist called ME to let me know the results of her device check and to call in a script for a blood thinner. No office visit required.

The chain docs offices with pa's and np's as your pcp, it's all about billing insurance.
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Nomad is correct. The doctor needs to have the patient present. The neurologist will have to do his own testing before he will diagnosis. You can ask that you speak alone with the doctor after the exam. But, you may want the doctor to sit down with your Dad, look him in the eye and tell him what is wrong with him. That's what Moms doctor did. Explained that she may see people who no one else sees, etc. He may believe the doctor before he believes you. Ask when you make the appt if they want the results of the MRI before the appt. Make a list of all the things you have seen regarding Dad. Ask that the doctor see this before the exam. His exam will be such to look for this stuff or ask Dad questions regarding what you have written.
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I agree: the idea of going to the appointment without him sort of put me in mind of the sign outside the beauty parlour "EARS PIERCED WHILE YOU WAIT." It's not impossible to do without him but...

I don't know if this might be more palatable to him: explain to your father that this is a follow up to the MRI scan, i.e. without going into detail about what you think the neurologist might be looking for, and that now he's spent all that money on the scan he might as well hear the results.
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Yes insurance only pays for appointments with patients who are present. Yes most doctors don't charge for phonecalls as followups to appointments. And:

Most HealthCare PoA documents are intended to empower the POA only when the patient is no longer conscious (or at least, not presently competent). If the patient has not been adjudged incompetent by his doctor, then the POA-person generally has no powers. Many doctors will discuss with the family anyway, especially if the doctor sees that there is at least a question about competence, and also if the family member has accompanied the patient to the doctor in the past.

Be aware, though, that asking to see the doctor without the patient present, especially to discuss brain imaging or cognitive impairment, can be seen (by the patient, for sure, and sometimes also by the doctor) as 'trying to railroad the patient into treatment or a facility without their consent.' If you wouldn't want a spouse to do that to you, don't encourage a spouse to do that to him.
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My sister informed me you, the patient can get written results of MRI. Our children & I have gone to my husbands doc appts. No problem & a) heard first hand what Dr. Said. My husband seemed to never really listen or get what the Dr. said but we all asked questions. I also gave in advance what was happening for Dr. To know before we entered. It's been a slow 11 years. Traveling 2 or 3 days 1200 miles brings out worst & then back to his normal.
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Is your father able to communicate for himself. A power of attorney is al right to be present but the patient re: your father needs to be there as well it his appointment also does your father have a health care sergant. If there isn't a health care sergant usually married couples sign off on one another. If the family decides a trustworthy family member should be assigned the sorrgant.
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My wife is Bipolar and I have been going to all of her appts for at least 20 years. She had her first stroke in 2003 and the most recent in 2017. Yesterday, she had an appt with her neuropsych and he asked her a few questions and upon seeing her ability to answer properly and appropriately he asked me to his private office and asked her to stay in the exam room . He then asked me more questions about her current condition, care and my concerns. I am her POA. Having a previous relationship with the drs helps in many areas that may come up later.
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Yes my mom is the active POA...we took the suggestion of paying out of pocket and it worked! My mom and I have a consultation set up. My Father was seen by a Speech Pathologist in the hospital, and I am one myself, so between her assessment, our day to day observations and the MRI results we have a good amount of info to share w/ the neurologist, as well as, hopefully gaining some detailed insight into the MRI results! Baby steps...
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Previous answers have pretty much covered everything, but here are a few points based on my experiences caring for my Mom w/ Alzheimer's. Many times a POA addresses only management of finances, not health issues. A separate document designates someone as Health Care POA, Health Care Surrogate, Health Care Representative or some other terminology. That's usually enough for health care providers to willingly speak with / include you in caring for another. They may also want the patient to sign a HIPAA form authorizing them to share medical info with you - assuming the patient is able.
Note the wording on POA and HCPOA documents sometimes authorizes the designate to act immediately (regardless of patient's condition) but other times requires the patient be declared incapable in some way. The former is far more helpful to a caregiver than the latter.
With the proper legal papers, I've found almost every medical provider is happy to include me in my Mom's appointments. But it's still necessary that my Mom be present because insurance covers her, not me. In most cases, I've been able to let the provider know (at the appointment or maybe ahead of time) that I would like a few minutes alone with them. Rarely has anyone been hesitant about discussing things with me alone. It's pretty clear after a few minutes with my Mom that she's not able to convey meaningful information or understand what the doctor has to say.
So make sure the provider has appropriate health care authorization papers then let them know you'd like a few minutes alone with them at your Dad's appointment. Usually that works.
Good Luck!
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