Tag Archives: Health care

Medical Bills- Fight for lower costs

Lowering your medical bills

It’s a known fact in the world of bankruptcies that most debtors don’t charge up insurmountable, irresponsible credit card debts after a wild spending spree than head to their bankruptcy court to discharge the debts. Bankruptcy filings are less about lavish lifestyles and more about misfortune and high medical bills.

Unbelievably over the last 10 years we have seen bankruptcies filing skyrocket due to medical bills. Bankruptcy filers are increasingly middle-class, well-educated homeowners who faced an unexpected medical crisis and have been unable to pay their medical expenses.

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Health care- Third party payer system to blame for rising costs

One of the biggest concerns for disability applicants is health care. Many Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI)applicants do not have medical care, insurance or sufficient funds to go to the doctor and get a diagnosis and good healthcare. The question most applicants in this situation ask is, “How do I get good health care if I cannot see the doctor?” The second question which follows is, “How do I get SSDI or SSI without evidence of my disorder?” These are both great questions, and unfortunately, the answer generally is it will be very hard to do either.

English: U.S. Health Insurance Status (Under 65)

English: U.S. Health Insurance Status (Under 65) (Photo credit: Wikipedia)

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SSA Disability – Does the SSA provide medical care?

There are thousands of Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) applicants who have a disability and who are unemployed and do not have medical insurance to pay for medical care.

One of the most common questions on our forum is, “Will the Social Security Administration provide medical care for me?” This question is asked in a variety of different ways so it is not always clear if the claimant is asking if they will get medical insurance after they are approved for SSDI or SSI or if the SSA will provide medical care for the applicant during the application process so they can get the medical care they need to diagnose their condition. In this blog we will address both issues.

Does the SSA help me get a diagnosis for my condition?

Ideally, prior to applying for SSDI or SSI benefits you will have already seen a qualified medical source (licensed medical doctor, psychologists, optometrists, podiatrists, speech-language pathologists, etc.) for medical treatment. If you have not seen the proper medical doctor and you lack sufficient medical evidence to prove you are disabled and unable to perform substantial gainful activity, the SSA may choose to send you to a consultative examiner for a medical review.

The consultative examiner will provide a diagnosis and information to the SSA which may be sufficient to win your SSDI or SSI disability case, but they do not provide medical treatment.  In theory it is possible that a C.E. could evaluate your conditions and provide sufficient evidence to the SSA that you are disabled and unable to work, but unfortunately, most of the claimants we hear from are complaining about the brevity of the exam and are denied benefits.

The consultative examination should not be considered “medical care.” They do not provide ongoing treatment for medical conditions, and although they provide information to the SSA about your diagnosis and limitations to work, the bottom line is you should not rely on their evaluation to ensure you win SSDI or SSI benefits.

Does the SSA provide medical care if I am approved for SSI or SSDI?

If you are awarded Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) you will get medical insurance. SSDI provides Medicare to applicants 24 months from the date of their disability. SSI claimants, in most states, will get Medicaid at the time of their approval (some states require the applicant to apply for Medicaid separately while other states do not automatically award Medicaid even for SSI recipients).

So while the SSA does not specifically manage your medical care or send you to doctors, if you are approved for SSDI or SSI benefits you should have a government medical insurance plan that may allow you to get affordable medical care for your health conditions. In fact, for many disabled applicants the option of affordable medical care may be worth more to them than the monthly cash assistance payments.

The Bottom Line

Because the SSA makes their disability decision based almost exclusively on your medical records it is imperative that you get proper medical treatment for your condition. As mentioned above, you may be sent to a consultative examiner but this medical evaluation is seldom helpful for most claimant’s SSDI and SSI cases.

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Can I keep my doctor?

Recently on our forum a claimant asked, “Can I keep my doctor if I am approved for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)?”

English: Spending on U.S. healthcare as a perc...

Spending on U.S. healthcare as a percentage of gross domestic product (GDP). (Photo credit: Wikipedia)

The good news is that if the claimant is asking to keep their doctor than they have a doctor and they are getting medical care for their condition, which is the biggest way to improve your chances of winning SSDI or SSI. Winning benefits quickly and easily generally can only be done if you are seeing the right doctors and specialist and doctor getting medical care for your mental or physical health condition.  The right doctors can include qualifying medical sources:

  1. Licensed physicians (medical or osteopathic doctors)
  2. Licensed or certified psychologists.
  3. Licensed optometrists
  4. Licensed podiatrists
  5. Qualified speech-language pathologists

Will I get medical insurance if I get SSDI or SSI benefits?

Claimants who are approved for SSDI will get Medicare 24 months after the date of their disability. SSI recipients will get Medicaid, in most states, at the time of approval. So to answer the question, “Can I keep my same doctor?” really will come down to whether or not you get SSI or SSDI benefits and whether your doctor accepts these insurance plans.

What doctors take Medicare and Medicaid?

There have been studies done by professionals in the healthcare field which have evaluated whether there were a large number of doctors who refused to treat Medicare patients because of the low reimbursement rates and burdensome paperwork requirements.

Details of the reports show that over a three year span in the mid 2000s there was a reduction in the number of doctors willing to accept Medicare patients. But subsequent reports indicated that up to 90% of doctors still are willing to accept Medicare; however, there were “problems in certain geographic areas and where doctors might accept Medicare patients only in limited numbers.”

SSI and Medicaid

SSI recipients will have a more difficult time finding a doctor who accepts Medicaid, although many of the SSI applicants have not had insurance in the past so they may not have been seeing a specific doctor. Recent estimates suggest that less than two-thirds of doctors will take new Medicaid patients.

Why won’t doctors take Medicaid? The general consensus is that Medicaid payments fail to cover even the most basic costs of seeing the patient, and if the doctor takes Medicaid they may not be paid for their medical services.

In recent years, an increasing number of doctors have lowered the number of Medicaid patients they are willing to accept and treat. How does this refusal affect the rest of America? Patients who cannot get routine medical care may seek expensive treatment for their conditions at the emergency room which substantially increases the cost of medical care for all Americans.

Bottom Line

Many claimants who apply for SSDI or SSI and who have been out of work for months or years are glad to receive any type of medical insurance. Other claimants have a strong doctor/patient relationship and want to continue to see their doctor. For these claimants it may be difficult to continue to see their doctor, especially if they are now getting Medicaid. Talk to your doctor about your medical options for continued treatment.

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Can I get Medicare or Medicaid if I am denied disability benefits?

It is not uncommon for many Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) applicants to need medical care more than they need the monthly cash

WASHINGTON, DC - OCTOBER 26: A woman holds a s...

assistance of disability payments. Medical costs have skyrocketed and finding affordable healthcare is challenging, even for employees who are able to work and receive insurance through their employer.

But what if you are unable to work? What are your options for insurance and medical care? The Federal Government offers two medical insurance programs to qualifying applicants- Medicare and Medicaid.

What is Medicare and can I get it?

According to the Social Security Administration (SSA), “Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those who have disabilities and those who have permanent kidney failure. The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.”

So can SSDI or SSI applicants get Medicare if they are approved for disability benefits? SSDI recipients can, but they will have to wait 24 months from the date of their disability. SSI recipients will not, however, receive Medicare, but they will receive Medicaid, in most states, at the time of their approval.

What happens if you are denied SSDI benefits and you are under the age of 65? Do you qualify for Medicare? Unfortunately, the answer is no. There may be other private insurance options or you can attempt to pay cash for medical care, but Medicare is not an option.

What is Medicaid and can I get it?

Medicaid was created under Title XIX of the Social Security Act in 1963. Its main objective is to help low-income families and children have access to affordable health care. Many states also provide Medicaid to low-income pregnant women and children under the age of one.

States administer their own Medicaid programs, although the funding comes from state and federal government programs. Eligibility guidelines are also determined by the state.

Supplemental Security Income (SSI) recipients may, in many states, get Medicaid automatically when they are awarded SSI benefits. Some states require SSI recipients to file a separate Medicaid application form, and the remaining states do not automatically award Medicaid to SSI recipients unless they meet other criteria.

What if I am denied SSI or SSDI, am I still eligible for Medicare or Medicaid?

As mentioned above, SSDI applicants who are denied SSDI benefits will not be awarded Medicare because they are not 65 years or older nor disabled. SSI applicants who are denied SSI benefits may still qualify for Medicaid but it will depend on the requirements determined by their state.

What are my options if I cannot get Medicaid or Medicare?

On our disability forum many disability claimants ask, “How do I get medical care if I cannot afford insurance?” This is probably one of the toughest questions to answer because there is not a good answer.

Some doctors will take cash payments for basic medical services, but if a claimant is out of work they may not have any money. Without good medical care it is tough to prove a claimant is disabled. Unfortunately, the system is broken.

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