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No Insurance, can I get disability benefits?

We recently had a claimant on our disability forum ask, “If I do not have insurance how will this affect my chances of getting Social Security Disability Insurance (SSDI)? The truth is without great medical evidence that you have a severe health condition and this condition is so severe you cannot work for at least 12 continuous months it will be next to impossible to win benefits. Whether or not you have to have insurance to get this information is debatable.

What type of information does the SSA need to determine I am disabled?

The SSA expects that claimants will seek medical treatment from what they call “qualifying medical sources.” Qualifying medical sources include:

  1. Licensed physicians (medical or osteopathic doctors)

  2. Licensed or certified psychologists.

  3. Licensed optometrists

  4. Licensed podiatrists

  5. Qualified speech-language pathologists

The SSA will also want you to have a diagnosis which outlines your medically determinable impairment. Your diagnosis should be substantiated with the appropriate medical reports, medical history of a claimant, clinical findings (such as the results of physical or mental status examinations), laboratory findings (such as blood pressure, x-rays), diagnosis (statement of disease or injury based on its signs and symptoms), treatment prescribed with response and prognosis.

Now, do you have to have insurance to see a doctor or get this information? No, unfortunately, fi you do not it can be very expensive. I have a friend who does not have insurance but is able to go to clinics, the county hospitals and doctor’s offices, negotiate a cash payment plan and get the medical care she needs. She has the doctor write her an itemized list of the costs of each service and she decides what services to accept. When getting her teeth cleaned, for instance, she frequently rejects x-rays or fluoride rinses but leaves the office with clean teeth nonetheless.

You can use the same strategy. If you need an MRI because you have a severe back condition you can call around to various clinics and ask how much it costs. Variation in costs can be several hundreds of dollars. When I needed an MRI the affluent areas of town charged upwards of $900 but I called some of the less affluent areas and found a clinic willing to do the procedure for $500. Many clinics may also be willing to work with you on a payment schedule

Does it take more work to get medical care without insurance? Yes, but over time if you understand what you are trying to prove it may be possible to build a solid medical record. What information should you focus on? Focus on getting detailed information which clearly states why you cannot work, along with medical tests, blood tests, and thorough doctor’s notes.

What if I do not have enough medical evidence to prove my Social Security Disability Insurance (SSDI) case?

The Social Security Administration (SSA) will send you to a consultative examination if you do not have enough proof that you are disabled, assuming you meet the nonmedical requirements of SSI or SSDI. Unfortunately, this exam should not be considered medical care and is generally not helpful for your SSDI case.
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