When you apply for Social Security disability benefits, you’re not just going to the store for one quick visit. When you apply, you are starting a lengthy journey down a road filled with paperwork, interviews, and doctor’s appointments.
Unfortunately, the toughest part of this process is healthcare. Under the regulations, you have the responsibility of proving that you are disabled. You have to show through medical evidence that you are unable to work due to your condition.
So wrap your brain around this concept: You are out of work. You have no insurance. Why do you have no insurance? You have no insurance is because you are not working. However, you have to prove you are disabled. How do you prove you’re disabled? You have to have medical evidence. How do you get medical evidence? You have to go to the doctor. But you can’t go to the doctor because you have no insurance. Why don’t you have any insurance? You can see where I’m going with this.
In my time as a Social Security Attorney, I’ve created what I called “Hierarchy of Health Care for Social Security Disability Applicants”. Under my hierarchy, I give a grade from A (highest) to F (lowest). Now, these grades are not based on the quality of healthcare. These grades are based on access and availability and in no way reflects the type, quality and sufficiency of treatment received:
Grade A – VETERANS ADMINISTRATION
PRO = Despite any complaints or reservations that can be made about the Veterans Administration, their level of health care is quite frankly the best. If you qualify for VA benefits, you don’t have to worry about co-payments or monthly premiums. You have access to any VA facility nationwide. They have every doctor and specialist. More importantly, they keep an in-depth and detailed documentation of any condition, treatment, medication, conversation, or appointment you have had.
CON =The only drawback with the VA is the that doctors typically will not complete assessment forms. As a result, you are limited to just relying on the medical records.
Grade B – PRIVATE INSURANCE (Yours/Mines/Ours)
PRO = If you’re lucky, you have your own private insurance. It doesn’t matter if you’re on your spouse’s policy, workers compensation policy, long term disability policy, short term disability policy, or your own personal policy. Also, under most situations, the doctors are more inclined to complete assessment forms for you if you need them.
CON = At some point, someone is paying for these insurance policies you’re paying out of pocket. In addition, depending on the policy, the coverage may expire or come with a lot of additional stipulations that may limit or eliminate your coverage.
Grade C – PRIVATE PAY
PRO = On some rare occasions, some individuals have the ability to pay for medical treatment directly out of pocket. In this situation, people can pay for medical treatment directly with minimal resistance. Anything you need, you can pay for directly.
CON = Most people can’t afford the advanced level of treatment as the levels of specialties increase somost people quickly run out of money.
Grade D – GOVERNMENT INSURANCE
PRO = Some counties and cities provide local health care. If you don’t have any financial resources or insurance, this health care is the best you can receive. It’s affordable and accessible.
CON = When governments cut funding, this program tends to be among the first to be cut. Also, the wait for doctor’s appointments can be very long. The facilities that take government health insurance may not complete forms. In addition, some programs operate under a “share of costs”, which means the person may have to pay a certain dollar amount out of pocket before the insurance covers any other treatment.
Grade E– COMMUNITY BASED HEALTH CARE
PRO = Some cities have free clinics or low cost clinics. These places are wonderful. If you don’t have any insurance, you can get some care here.
CON = Very few of these actually exist. In addition, most people can’t afford the medications prescribed at these clinics, and the wait to get treatment may be very long.
Grade F – NO treatment / Emergency care
PRO = Unfortunately, there are no benefits to this treatment. In some instances, people will get treated at the emergency room if their condition gets bad.
CON = No way to provide proof of your medical condition.
The reality of healthcare for Social Security is a devastating phenomenon and can be even more traumatic than the process itself. Unfortunately, the system wasn’t designed to provide healthcare assistance so people applying can get the medical evidence they need to prove they are disabled. The reality is that healthcare is one more added stress to an already difficult process.
