The Reality of Healthcare for Social Security Applicants
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.
Reeves Social Security Guide #1: Medical Myths and the Patients Who Believe Them (or Six Simple Myths That Cause Confusion Regarding Your Social Security Disability Claim)
I spend a lot of my time explaining the Social Security Disability process as it relates to doctors, medical records, and evidence, that I feel if I could put doctors and their patients in one room, I could really clarify a few myths people have about the process. It’s tough because people are already frustrated with a lengthy and difficult disability process. The process gets even more difficult when people find themselves misunderstanding how it all works.
In an effort to address these misunderstandings, let me tackle a couple of the more common myths:
#1 Myth: “My doctor told me that he/she thinks I’m disabled”.
Tip #1a (For the patient) – Don’t believe it until you SEE it
Tip #1b (For the doctor) – If you SAY it, you’d better write it.
Reality #1 – I can’t tell you how many times I have had clients who legitimately believe that their doctors have told them that they are disabled. Now, I’m not disputing that’s what their doctor told them. However, it’s amazing the number of times I have looked through the medical records only to find that there is NO mention of a disability in their treatment notes. So I always tell my clients that unless they literally see a disability statement in their records, don’t blindly believe that it is going to be there. For my doctors, I know you know this already but your patients are hanging on to every word you say. So if you even hint or whisper at the possibility that you think they are disabled, they are going to hold you to it.
#2 Myth: “My doctor told me that they will write a report that will guarantee I get disability.”
Tip #1a (For the patient) – Your doctor doesn’t know the law.
Tip #1b (For the doctor) – If you really want to help, ask the appropriate party for guidance.
Reality #2 – I hate to be the bearer of bad news to my clients but I have to remind them that their doctor doesn’t know the law. Your doctor can’t guarantee you’re going to get disability benefits. Now, don’t get me wrong. In most instances, the opinion of a treating doctor holds substantial weight, and the Social Security Administration places a lot of importance on receiving their records. However, if there are some additional issues with your case, or you have other medical records that have contrary findings, your doctor’s report may be ignored.
#3 Myth: “My doctor will fill out a form that will help me.”
Tip #1a (For the patient) – Be careful what you ask for…
Tip #1b (For the doctor) – Make sure your form is supported by your records.
Reality #3 – You have to be careful when you ask for an assessment. If you are not confident of what the doctor is going to write regarding your limitations, he/she could actually hurt your case. For doctors, it is equally important that the limitations you provide are supported by the medical records. Your records may be viewed with some degree of suspicion if you say the person can’t do anything due to pain and all you’re giving them is ibuprofen.
#4 Myth: “My doctor is waiting on a statement from my representative before he/she writes a letter.”
Tip #1a (For the patient) – The doctor doesn’t need a statement from your attorney.
Tip #1b (For the doctor) – If you intend to write a letter, write it and put it in your patient’s records.
Reality #4 – Contrary to popular belief, a doctor does not need a letter from your legal representative in order to write a medical letter supporting your claim. Your doctor can write the letter and give it to you. He/She can write a letter and fax it to your representative or directly to the Social Security Administration. He/She can write a letter and put it in your medical records. Trust me, he/she doesn’t NEED anything from anyone in order to write a letter on your behalf.
#5 Myth: “Once Social Security sees my records from my doctors, I should get approved.”
Tip #1a (For the patient) – You don’t know what your doctors have written.
Tip #1b (For the doctor) – Make sure you write what you’ve said.
Reality #5 – The Social Security Administration must consider all of your medical records. As such, if you have gone to a variety of different doctors, they are going to review and assess all of those records. They are going to give more weight to certain documents and discount others. In addition, the simple fact is you probably have not seen all of your records so there is no way of knowing what your records may say.
#6 Myth: “My doctor is willing to help me with my disability claim.”
Tip #1a (For the patient) – Ask for a letter, an assessment, or an evaluation.
Tip #1b (For the doctor) – Ask for the names of other doctors and review all other records.
Reality #6 – To all of the patients out there, if you are lucky enough to have a doctor who sincerely wants to help you, you can tell him/her to do a few things for you. Ask your doctor to write a letter about your condition. Ask your doctor to write an assessment or send you for an evaluation. To all of the doctors, if you truly want to help your patients, you can, also, do a few things. Ask for the names of your patient’s other doctors and get those medical records. Once you’ve done that, review those records (make sure you note in the file that you have) and give an assessment of the patient’s situation.
I know these things may seem obvious but you would be amazed by the number of people who have found themselves getting frustrated because they don’t realize how their medical records and their doctors affect their cases. I hope this helps.
Same Sex and Social Security: The Federal Court Battle Begins Today
Several months ago, I had the opportunity to represent a couple in their claims for Social Security Disability benefits. My heart went out to them because they both had significant health problems and they needed as much help as they could get. Whenever I had a chance to talk to them as a couple, they made me laugh. With their cursing, arguing, and eventual flirting, it was clear to me that the two of them were very much in love. They were dedicated to supporting each other and they were very aggressive and passionate about making sure no one took advantage of the other person.
I am happy to say that both of them won their disability claims and I sincerely hope that their quality of life improves. However, as I talked to them, I wondered one thing. What happens to their benefits if one of them dies? The reason I ask is that they are a same sex couple. Under federal regulations, a surviving spouse may be eligible to receive the deceased spouse’s disability benefits, but this may not be true for same sex couples.
To decide your relationship as the insured’s widow or widower, the Social Security Administration looks to the laws of the State where the insured had a permanent home when he or she died. So, in essence, if your state doesn’t recognize same sex marriage, neither will the federal government when it comes to Social Security benefits.
Up to now, the issue of the constitutionality of gay marriages has been a ‘state court fight’. However, a federal judge in San Francisco will hear closing arguments today (Wednesday, June 16, 2010) in the first federal trial to consider the constitutionality of a gay marriage ban. The judge is expected to rule on whether California’s gay marriage ban, Proposition 8, approved by voters in November of 2008, violates the U.S. Constitution. The decision in this case probably will not not be the final one and we can expect it to go all the way to the United States Supreme Court.
Which brings me back to the couple I represented. I wonder how this case affects them. No, they are not married, and, no, I haven’t heard them speak at all about survivor’s benefits. They are a ‘happy go lucky’ couple just getting on each other’s nerves like every other couple. But they are not like every other couple. They happen to be gay. Still, they are committed to taking care of the other person’s needs. They pay taxes. They are American citizens. So why is a program dedicated for the benefit of the American people not available to all of the American people? How is a state permitted to decide just who is entitled to federal benefits designed to provide benefits to survivors of loved ones?
I don’t know but we may be getting close to a resolution on this one.
Never understand what is happening in the mind: Mental Health conditions and Social Security Disability
Mental Health conditions are some of the most devastating conditions that can afflict a human beings. Most of the time when we hear about them, they usually are in relations to two circumstances:
1) Somebody popular
Chynna Phillips of the pop group Wilson Phillips checked herself into rehab for anxiety over the weekend, her manager, Lizzie Grubman, tells PEOPLE exclusively.
2) Something traumatic
Thursday, Joseph Andrew Stack flew a small airplane intentionally into an IRS building. The IRS had 199 people who worked there. Joe Stack set his house on fire, left what is being considered a suicide note, and then flew his Piper Cherokee PA-28 into the Austin, Texas IRS building.
The brain is always going to be considered a mysterious organ. Of all parts of the body, this part is the one that continues to baffle the medical community. So it should come to know surprise that it can be difficult to ascertain the severity of a mental health conditions.
The mental health community relies heavily on a variety of different diagnostic testing, personal history, and mental status examinations to try to get a picture of how severe the mental health condition may be. It’s tough but the information these providers obtain is valuable and necessary if you are attempting to obtain medical benefits.
Regularly, I get asked by my clients what types of things does Social Security look for when trying to determine the severity of the medical condition. Here’s a few things you should consider:
1) The type of doctor tells alot.
I hate to tell you but SSA tends to give a bit more deference to a Psychiatrist or a Psychologist who is treating your mental health condition. There is nothing wrong with your family doctor but a specialist (Psychiatrist or a psychologist) tends to get greater favor. Now, before you ask, there is nothing wrong with going to a Mental Health counselor. However, it is helpful if the counselor is working with you in conjunction with a psychiatrist as part of a mental health plan.
2) The type of medicine you take says alot
Some medications give a clear indication of the significance of your mental health condition. There’s nothing wrong with Paxil or Zoloft. However, Risperdal and Geodon gives an indication of a much more serious mental health condition.
3) The BIG 4 things you need to know (Concentration, Memory, Crowds, Stress)
These are normal questions that are asked that you should give some thought to HOW you are going to respond. How is your concentration? Do you forget things? If you do, what do you do if you need to remember things? How are you around crowds? How many people is TOO many people?
4) Other THINGS MATTER
You have to remember that how you function in your day to day life matters. If you say that you can’t be around more than one person att a time but you go to church every other day (where you would expect to be MORE than one person), your response may be viewed as suspect.
5) Involuntary Admission
In Florida, the term “BAKER ACT” refers to an Act that permits for the involuntary admission of an individual into immediate psychiatric care for a short period of time. Every state calls it by a different name but this usually refers to a situation where a person expresses an intent to harm him or herself or someone else. These admissions may indicate the presence of something more severe.
6) STAY AWAY from the DRUGS (ILLEGAL DRUGS)
Let me blunt. Mental Health and Illegal drugs don’t mix. And when you’re applying for disability, you force SSA to try and figure out WHAT came first (the drugs or your mental health condition) and more important, do you get better if you’re NOT using drugs.
Like I said in the beginning, mental health disorders are tough and millions of people affected by these disorders are able to live productive and functioning lives. However, it’s important to realize that if you’re alleging that you are disabled due to your condition, you must understand that the few things I mentioned above may have a lasting impact on your ability to obtain disability benefits.
The hardest part about proving you’re disabled is relying on the medical treatment you are STUCK with
Today, a report was issued regarding the healthiest counties out 3000 counties nationwide.
Overall, the report found least healthy counties have childhood poverty rates more than three times higher than the healthiest counties. Residents of the least healthy counties are 60 percent more likely to be hospitalized for preventable conditions, a sign of poor primary care. A third of zip codes in the least healthy counties have at least one grocery store, compared to almost half of zip codes in the healthiest counties.
http://www.countyhealthrankings.org/
Of course, this information is probably not going to be broadcast on twitter, facebook or myspace. And with the winter olympics and the BACHELOR going on, few will truly appreciate the impact of this report.
What does this report tell you? Quite simply, as stated in one article, “Looking at each state’s best and worst further illuminates a well-known trend: The least healthy counties tend to be poor and rural, and the healthiest ones tend to be urban or suburban and upper-income. ” http://www.chicagotribune.com/health/chi-ap-us-med-countyhealth,0,2482605.story
Unfortunately, this doesn’t help the millions of people who are applying for Social Security Disability benefits. Why am I stressing this point? Quite simply this. The person bears the burden of proving they are disabled. The government doesn’t have to prove a thing. However, this presents a unique situation when you are sick, you aren’t working and you ‘DON’T HAVE INSURANCE’. So what do you do when you have those things striking against you? Well, you can either go to the free clinic, go to the Emergency Room, or get on the county health insurance.
Here’s how it gets tricky but you gotta try:
1) Ask about free clinics
You gotta ask your health care provider, the ER, social worker, county services, or non profits about free medical clinics. I always tell people that free medical treatment is better than NO medical treatment.
2) Find out if you qualify for county health insurance
Every county is different so you want to check to see if you qualify for any type of medical insurance that the county may offer. You don’t know unless you try. AND, if it’s available in your county but you haven’t tried to get it, it may count against you.
3) if you have a “SHARE OF COST”, make sure you understand what it means
A ‘SHARE OF COST’ basically means that you are responsible for a certain amount and anything above that, the government will pay. However, it gets funky because some people don’t understand how that works so you want to make sure you get a complete explanation so you can get treatment.
4) Go to the ER if your condition gets worse.
The Emergency Rooms are flooded every day. Unfortunately for some people, the only primary treatment they can get IS the ER. Don’t be afraid to go to the ER. At least you can get something if you HAVE to get treated.
5) Make SURE you tell SSA that you’ve done ALL of these things
I can’t tell you how many times I’ve had people who literally didn’t do anything. They didn’t go to the county. They didn’t go to the ER. They didn’t go to the free health clinic. AND YET THEY STILL say they can’t get any medical treatment. You gotta try in order to show SSA you made the effort.
I know that is difficult but you have to make the best of what you have available because in the long run, only YOU can prove that you are disabled.
