When It Comes to healthcare and Social Security Disability, It DOES Matter Where You Live
I remember living in a county that was doing away with its county health plan. People who had been relying heavily on the county’s plan were freaking out because they no longer would have the ability to get the care they needed. This fear was magnified for those who applied for Social Security Disability benefits. When you apply for Social Security Disability benefits, you bear the burden of proving you are disabled. So, you need medical care.
Some cities, counties and even states have their own health care systems that provide medical coverage for their uninsured and under-insured residents. Sadly enough, in this economy, many of those municipalities are having to do away with their programs. So it should be no surprise that some people find themselves rotating from city to county to state in order to find a place that has a program that best serves their needs.
This health care migration isn’t limited just to people moving from state to state. A number of citizens have found themselves leaving the United States heading to places like Canada, Mexico, Jamaica, or Costa Rica because the cost of healthcare in those countries is significantly lower. When you factor in surgeries, medication, office visits and all of the other things associated with healthcare, some people just can’t afford the high cost of long term care in America.
It’s sad that when people are trying to obtain disability benefits, they are forced to muddle through a healthcare system that makes it difficult for them to receive the necessary treatment. Unfortunately, when it comes to getting disability benefits, it DOES matter where you live.
A Story About A Social Security Disability Claimant: An American Tragedy
In 2008, a 27-year-old man (let’s call him John) was enjoying his work as a Supervisor, making about $4,000 a month. Life was good and his opportunities were endless. He was working for a company with great benefits and was enjoying the American dream. He had a beautiful stay-at-home wife, two lovely kids, a nice car, and a lovely home. He’d been smart, saved his money and made some good investments. By all accounts, he was a success.
But, in the fall of 2008, his life took on a turn. He woke up one day and had difficulty talking. He was numb on one side of his body and he struggled to walk. He didn’t know what was wrong. His wife rushed him to the hospital. Doctors kept him overnight and determined he’d had a stroke.
John spent a month in the hospital before regaining his ability to speak. During that time, he used his sick time and Family Medical Leave . When he got out of the hospital, he still dragged his left foot, experienced memory loss, and loss of some muscle coordination. Two months went by and he was still having problems. He used up the rest of his vacation time and decided to quit his job because he wasn’t sure when he would be healthy enough to return. Unfortunately, he didn’t have short term or long term disability so he was out of insurance. In order to take care of the family, and support the house, his wife had to go to work. Eventually she found a job, but couldn’t afford to put John and the kids on her insurance so she insured the kids.
Unable to find a free clinic or any providers who would take him on a low cost basis, John had to take money out of the savings and investments to start paying for private insurance and treatment. After about 7 months, he tried to go back to work and found a job as a toll collector. But he continued to have memory problems so his cash register is always off. He was let go after working only three weeks. To make matters worse, he suffered a relapse and had to go back into the hospital for a couple of weeks. When he got out, he had an expensive hospital bill to pay but no ability to pay it. By this point, 10 months have gone by and John has no insurance, no savings, and no investments. So he decides to apply for Social Security benefits.
Unfortunately, it’s a long process. It takes five months from before he gets a denial. In that time, his wife has begun working two jobs because they can’t afford the mortgage and car note . They lose the house in foreclosure and have to move in with her parents. John appeals the denial, waits another six months and is denied again l. In that time, the family’s car is repossessed. He appeals to go before a judge and now is told that he has to wait another 12 months. Twelve months of no insurance, no health care provider, no car, and no home. John’s wife struggles to pay for the few visits that he can attend at a local doctor. It’s not much but it’s something. Twelve months later, he has a hearing. After the hearing, he has to wait three to four months for a decision. Finally, he gets the good word he’s been waiting for: a fully favorable decision. He’s been approved. Now, he’ll have insurance coverage. Now, he’ll have some money.
However, to his surprise, he only gets $1200 a month. He gets a lump sum going back two years in the amount of $24,000 but John has so many bills and debt that the money is gone in less than a month. Now, the question is: How do you start back over? The money is not enough to put them in the position as they were in before. So what do they do?
This story may sound like fiction but it is not. There are thousands of Johns-and Janes-who go through this every day while trying to put their lives back together after something devastating has happened. It’s a tragedy and unfortunately, it’s an American tragedy. So what do we do to fix it?
How Much More Can the Gulf of Mexico Take?
For me, a Social Security Disability attorney practicing in Florida, hurricanes take on a different level of significance. From a personal standpoint, like everyone else, I have to be ready to move on a dime. When a hurricane comes through, I’m forced to keep a full tank of gas, extra batteries, and a portable radio at my disposal. But from a professional standpoint, I have to be prepared to account for a major disruption in my business practices.
I didn’t truly appreciate these standpoints until 2005, when Hurricane Katrina hit. For Florida, Hurricane Katrina didn’t cause a lot of damage. However, we all know how devastating the storm was to Alabama, Mississippi and Texas. What I didn’t expect was the long-term and far-reaching impact. Shortly after the storm passed, we saw a large migration of people from Louisiana to states like Texas, Arkansas, Georgia and Florida. I found myself representing quite a few Katrina survivors.
I didn’t think representing these survivors would be difficult. I had been practicing about 4 years at the time and I had pretty much seen it all. Orso I thought. As I prepared my clients’ cases, I made the customary request for copies of their medical records, which, of course is necessary to prove they were disabled. Unfortunately, I couldn’t get them.
I was experiencing a whole new level of difficulties. I can still remember some of the stories. One medical center floated away. Another medical facility was completely destroyed. One place had half the records for all of their patients but they had to do a thorough inventory to see what they did and did not have. And let’s not forget about the Social Security Administration. Some of the offices were completely destroyed so in some instances, they didn’t have the files for my clients. As a result, we literally were reconstructing files with little or no information of their claims. Social Security representatives from Texas were coming in to the area to assist with the process.
I was mind blown. It’s one thing to have to go through a difficult process with very little money, very few resources, and very little support. Imagine what it is like to go through that process and have no way to prove that you are disabled.
So, with hurricane season upon us and BP trying to clean up this mess, I truly wonder if people realize how crucial things can get along the Gulf Coast.
In the last 5 years, the Gulf Coast has been hammered! Hurricane Charley, 2004 – Category 4, total US damage $15 billion dollars in cost (2nd costliest hurricane in US History)
Hurricane Frances, 2004 – Category 2, damage $8.9 billion, over 90% of which occurred in Florida.
Hurricane Ivan, 2004 – Category 1, U.S. damage is estimated to be near $14.2 billion, the third largest total on record.
Hurricane Dennis, 2005 – Category 3, caused considerable damage across central and eastern Cuba as well as the western Florida Panhandle, including widespread utility and communications outages.
Hurricane Katrina, 2005 – Category 5, one of the most devastating hurricanes in the history of the United States. It produced catastrophic damage – estimated at $75 billion in the New Orleans area and along the Mississippi coast, and is the costliest U. S. hurricane on record.
Hurricane Rita, 2005 – Category 5, devastating storm surge, flooding and wind damage in southwestern Louisiana and extreme southeastern Texas, with some surge damage occurring in the Florida Keys. Rita was responsible for seven deaths, and it caused damage estimated at $10 billion in the United States.
Hurricane Ike, 2008 – Category 2, storm surge devastated the Bolivar Peninsula of Texas, and surge, winds, and flooding from heavy rains caused widespread damage in other portions of southeastern Texas, western Louisiana, and Arkansas. Twenty people were killed in these areas, with 34 others still missing. Property damage from Ike as a hurricane is estimated at $19.3 billion.
The Gulf Coast region is only recently recovering from the massive blows that were felt from Hurricane Katrina. And now we have the BP disaster. This disaster is not like a hurricane that blows through and is gone. We know about a hurricane several days in advance and once it hits, you assess the damage and get to work. This disaster does not result in flooding, which will eventually subside. We are talking about a hole in the earth that is releasing massive amounts of oil daily! With each day, significant amounts of damage are occurring. And we’re not talking about one day or even a week. We’re talking now about more than 60 days of continuous bombardment of our eco system. We are talking about more than 60 days of a devastating toll on the socio-economic infrastructure of potentially 4 states. Maybe more.
What’s even worse now is that we are at the beginning of urricane season and, if any storm develops, all activities must stop until the storm passes. Heaven help us if a storm actually develops in the region.
Right now, law firms are gearing up to handle law suits against BP. However, these suits could take years. I can still remember all of the unique tactics I had to use to prove people were disabled when all evidence of their disability had been completely wiped out. The people are the ones who will take this blow the hardest.
I know the US has spent a lot of time on the BP crisis but after watching countless times as the people along the Gulf Coast try to rebuild their lives after each disaster, you have to ask the question: How much more can the people along the Gulf of Mexico take??
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.
Social Security Disability tips: Consultative evaluations
If you have some questions about Consultative Evaluations, please check out this video I created:
