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25 July 2008

Some people may think that... with $4 generic prescriptions at WalMart, someone receiving disability benefits from private insurance and Social Security could afford to not decide between rent and medicine. They would be wrong. [More:]

I finally found a doctor who could keep my blood pressure and cholesterol under control using only generic medicines. He even managed to whittle the number down to four. I thought my days of going without were over.

Nope. As always, external factors reared their heads, the worst being what has become the usual incompetence at Social Security. The worst problem is the disconnect between what the 800-number staff know about field procedures and the public's inability to contact the local office through jammed phone lines. The best hope lies in telling a convincing story and moving the person on the other end to call the field and straighten things out.

That problem concerned direct deposit. Underlying all else however, despite my case being adjudicated favorably last November, I still have not received back payment for the four years I waited for the process to conclude. That amounts to $48,000. I am far from alone. At any given time, 100,000 others are also waiting for their lump sum from the dreaded Payment Center, an office so inaccessible that even regular Social Security employees cannot reliably get through.

The obstacle creating this backlog is the sheer bulk of medical evidence needed to decide a case. The process is so complicated that lawyers who specialize in disability cases must collect and assemble medical records from every doctor involved, even indirectly. Then, both a judge and a rehab specialist at Social Security must go through that package to assure that every T was crossed.

Disability in the US is breaking Social Security. No one foresaw the surge in claims that followed 9/11 when so many jobless opted for disability over unemployment, and the inflow of new claims has increased steadily since. Worst of all, the process serves to make claimants even sicker by the time they do finally get access to Medicare, and in my case, a disabling condition that could have been temporary became instead irretrievably permanent.
i know this story far too well. Helping older people who need any consistent medication is long frustrating heartbreak and a week to week struggle.
Samples are your good friends. i don't know about the companies that are offering some kind of deal on medications, but they do advertise enough.
posted by ethylene 25 July | 17:14
I find it horrifying that the default is to reject everyone who applies for disability and force them to go through the expense of fighting it in court, no matter how obvious the case is.

Shoot, a friend of the family had his case denied. He was a construction worker who had been paralized. Since he could use the little mouth-control on his wheelchair to drag i-beams or something, I guess.
posted by kellydamnit 25 July | 17:50
The best part is that once you begin to receive your monthly "allowance," you still don't qualify for Medicare for a year. A year! How are you supposed to pay your doctors until then? The sum you are sent each month is so paltry that it is impossible to survive on, and being disabled you cannot work. Next there's the fact that you can't apply for other social services, because the cost will just be taken out of your SSI or SSA benefits. And finally? When you do get Medicare, they charge you $90-some odd dollars a month for it, so that the paltry living allowance you were receiving becomes meaningless. Oh! And there's a $200 deductible for Medicare. Where are you supposed to get $200? If you sign up for the prescription drug coverage you're even more screwed, because you end up having to pay more for your meds than you would if you were un-insured.

I was lucky enough to only have my case rejected once, and then to have my application approved relatively quickly afterwards. But it would be nice if that meant I knew where next month's rent would come from.
posted by brina 25 July | 18:00
I find it horrifying that the default is to reject everyone who applies for disability and force them to go through the expense of fighting it in court, no matter how obvious the case is.

I was denied my claim this week. I am still so upset about it. I'm glad I was able to bring it all to my therapist who I have a good relationship with. Thing is, it took at least a year for me to be able to actually apply and now I only have 60 days to organize my appeal, with no resources and a depression that seems to keep getting worse and worse. My therapist will help, there is that, at least.

The thing that gets to me is that the application was all about how much I can lift and how long, each day, am I expected, in my work, to stand. You know - this is hard, I don't ever talk about these things - my problem is mental illness. But there where NO questions in all the process where I was asked about my learning disability or my mental stability (I hate calling it "stability").

The state they had a Psychologist give an independent assessment for them, at their expense, he asked about my general health so I said I recently had a hear attack so, HE ADDED THAT AS A REASON FOR MY CLAIM. WTF!!!! The rejection letter went on and on about how my heart attack is not grounds for a claim 'cause I had physical therapy and I am now "healthy!"

I am so blown away at the way I have been made to disappear through this. I'm supposed to stand up in front of complete strangers and defend myself at a hearing when I can barely get out of the house most days. I mean, WTF?!

(breath, breath)

So, yea brina and others, I totally agree about how messed up the system is. It makes a person sick to participate. But that is what sick systems do. They organize to create sickness so that the system can be sustained. RIght now, I am actaully thinking that to be in the SSDI system may be the worst thing I can do on my road to recovery.
posted by MonkeyButter 25 July | 19:41
MonkeyButter, I'm right here with you. My app was for PTSD and depression, and it was almost impossible just to do things like ... wash my hair ... this time last year. But you're really lucky with your therapist and psychiatrist. You probably won't even have a hearing: once you file the appeal, an appeals judge will look at the paperwork, and if it is obvious you are seriously impaired, you could be approved within weeks. Then again, that depends a lot on where you are and whether the judge looking at your paperwork has a heart.

Can someone, in addition to your docs, help you with the paperwork? Honestly? Write a letter being very explicit about your limitations. Can you cook for yourself? Can you clean up after yourself? What do you do every day? What specifically would keep you from working? Are you suffering from insomnia or hyper-somnia? Having problems getting out of bed in the morning? What happened at your last job? Did you get fired, and if so, was your depression a factor? Do you have past employers who would vouch for you on this? Make it clear that you are filing for disability for major depression. Get additional letters from your doctors.

And if you need hugs, just come right on in here. I think there are more disabled folks here on MeCha than I've encountered anywhere else in my life.

Side note: How do those of you who receive SSI/SSA survive financially?
posted by brina 25 July | 20:35
i've helped people get SSI and disability. Most people i know who've gotten disability have either been in court for years, mostly leaving it to lawyers to pump it through the system over years, or have had someone push it through the system, which is easier to get fast tracked when you're in the system.

It's hard to say what helps anymore as there are frequent and local changes and priority criteria.
And i am tipsy.

Without people who are favorably intended to help grease the bureaucracy, i don't know who gets through the system in any timely manner.
posted by ethylene 25 July | 21:00
brina, I am making a list of people to be involved in the appeal. Basically, I will have my hand held by my therapist. It sucks but that's how it is gonna have to be. Also, the letter idea is a good one. I can use that as a therapy.

My biggest hurdle is going to be that I don't present as a person with a mental illness. I seem fine in person. What I have to communicate better are the hours it takes me, when I am alone, to get out of the house or into the shower.

It may never even come to a trial, so I'm not gonna sweat that . . . yet. I'm just gonna make a list and focus on one thing at a time. The letter comes first.

Well see how it goes.
posted by MonkeyButter 25 July | 21:53
I spent a couple hours today at my local SSA office, and a few minutes at foster care, and that's all it took to send me to bed at 4:00 in the afternoon.

I was at SSA with my older foster kid, who was just emancipated last week. The emancipation date's been set for weeks. I've been bugging the social worker to make sure that the payment gets switched from getting paid to the county to being paid to my kid. He assured me, yes, fine, and told me that the foster care people had sent something into the SSA. Then he told me to go in with Chris to SSA to fill out paperwork.

So then we went in to SSA. The, ahem, helpful woman told us that she requires a court order showing the emancipation. Ooookay. It would have been nice if someone had told me that.

I called the lawyer to ask her to fax it to me. Oh, but no! The SSA lady says we need a court order "with a seal." Um, they don't come with seals. Even the lawyer doesn't have one with a seal. "It needs to have a seal." Um, okay, well.

We go to foster care, they have the court order with the original "file" stamp, maybe that's what SSA means by a seal, but foster care can't give it to me. They can only give me a copy.

I guess I may have to make a special trip to family court. With my disabled foster kid. To get the order. With a seal. Or maybe the blue-ink "filed" stamp. Or maybe I can convince the foster care system people on Monday to loan me the special blue-ink court order for a few hours.

And, the SSA lady says there is no sign of any paperwork from the foster care agency. And that the payment won't switch until September. Okay, well, that's great, as the whole reason the payment is being switched is that my kid is being emancipated and is MOVING OUT on his own in two weeks.
posted by Claudia_SF 26 July | 00:23
Foster care system: Fucked up beyond belief.

Good on you, Claudia_SF, for hanging in there. You're a saint.
posted by mudpuppie 26 July | 00:28
None of my doctors were responsive to writing letters for me until after my lawyer contacted them. The evidence package that my lawyer produced at the the hearing was two inches thick and included medical tests that my attorney specifically requested. It contained my entire medical history back to 1997 as well as the letters from my doctors. BTW, to be effective, a doctor's letter must answer a SS checklist. "My patient is disabled as described in paragraph 7.b..." or some such.

As brina stated, Medicare does not start for a year, but the start date is the date the judge determines that disability started, which in my case was back in 2004. So, while on paper I had been on Medicare since 2005, my first access to it was in January of 2008. Now my medical insurance must bill Medicare for what Medicare should have paid for those three years. Hopefully, this process will remain invisible to me.

This also has an IRS element. Private disability insurance is taxed at normal rates, but only a percentage of Social Security Disability payments are taxed. Monthly payments from private insurance include what SS is supposed to pay.* Once I get the award letter, I have to file amended tax returns back to 2004. Effectively, I was overtaxed on money I was supposed to be receiving from the government but wasn't. I was paying money to the government when the government was supposed to paying me.

* For those interested, that is why I have been in a financial hole since June. I owe my insurance company the bulk of the lump sum payment from Social Security. While I wait for SS to process the payment, my insurance company deducts what I owe them from their monthly payment to me. Since what I owe is greater than what they pay, I get nothing until I pay back the lump sum.

This conflicts with what my HR department had told me, however a call to corporate HR verified that the insurance company was correct. I learned of this while I was in Amsterdam and expecting my insurance check to hit. It didn't. Luckily, effective anti-depressant and anti-anxiety relief was available without prescription at local coffee shops.

As for the direct deposit snafu, after spending two weeks trying to convince Social Security that they had transposed two digits in my bank account number, I thought all was over in that department. Well, no. Apparently I qualified for SSI during the first six months after my date of disability, and SSI mailed a check to an old address rather than my address of record, despite SS assurances that all payments would go through direct deposit.
posted by Ardiril 26 July | 15:01
All the best, Ardiril... hope things go more smoothly in the future.

(I don't know, though... a physical or severe psychiatric disability, like schizophrenia or chronic/uncontrolled bipolar disorder, I can certainly see, but if everyone who was depressed, even clinically depressed, was on Disability, it would bankrupt the system ten times over. In my own experience, work is good for depression. Takes me out of my own head.)
posted by Pips 26 July | 16:37
Today's Photo Friday has No Theme || Brandy, you're a fine girl.