Applying for Disability Response to
"Applying for Disability –
What worked for me" by Liz Thompson
Martina P. of Michigan
My name is Martina and I live in Michigan. I can only speak about things I have taken or experienced in this E-mail, so I want to share.
I did exactly what you said with the forms, filling them out, getting my Neurologists past and present to fill out and fax the paperwork. I also attended a medical exam by their SS doctors. I was denied right away.
The only thing I would add to your essay is to tell people not to get discouraged. As soon as you get the denial letter, take that immediately and all the paperwork you have to a lawyer that handles only (specializes) in Social Security Claims. I did.
By law, attorney's may only take up to $5300 of your back pay for services rendered. Back pay is established due to not being awarded an approval when you first applied. I was denied in 2003, at that time the attorney told me it would take 18 months before I would have an appeal trial with a judge.
The attorney was correct, but I feel I would not have gotten a date that soon if I had not been friendly to the paralegal (who did all the paperwork).
I would talk to her and tell "her" that I was in financial need and in danger of losing my home. Then one time upon calling her, she told me to hang up and she would check with the judge's scheduling clerk. When she called me back later in the day, she had an appointment for my attorney and I – so be nice to the people who do the footwork and try to get them everything they need as soon as they request it! "Prompt" follow-up is a great tool in getting what you need done.
While part of my back pay was taken (I had attended school for part of the time and just could not continue due to concentration problems and fatigue), I did not care. I was finally approved.
Make sure your doctors will stand by what they noted in your records. If he/they will not do that, then find someone who will. (Second opinion sometimes 3rd). You do not need a wishy washy doctor. You must be your own best advocate.
Your medicare approval will come after you have been on Social Security for two years. However, in my humble opinion in regards to prescription coverage (and I am speaking as of 9/25/06) do not take part D.
After researching Part D, I found that I would be required to pay in addition to medicare Part B premium, a premium for the drug coverage ($20-35 per month) plus a co-pay for each drug you have (I have three prescriptions). The more expensive the drug the higher the copay $325 for Rebif alone. $17 for Zoloft and $17 for Welbutrin. That's $359 per month so far plus the $88 for part B medicare payment that's a grand total of $447 per month out of my Social Security Disability Check.
Now the bad part . . . Yes there is more. . . After you pay up to $2,250 (not including part B's $88) there is a STOP GAP IN COVERAGE...where you have to accumulate up to $3,600 out of your pocket.
For me Rebif is $1700 per month, so for two months and 200 dollars of the third month, I am paying that out of pocket cost before the prescription insurance kicks back in to charge you only, only, only ...ready?? $75 per month, until next year when it starts all over again.
p.s. Have you added up my total out of pocket cost for the year just for prescriptions? It is $2,250 plus $3,600 equals $5,850 a year plus the $88 times 12 months (another $1,056) for part B medicare plus the premium per month for the part D prescription insurance ($20-$30) and the co-pay for each time I refill. Wow! a lot of figures...right? Yes, a lot of money out of my check, over $6,000 per year ($500 per month.) I don't think this is good insurance for us or our seniors. So if you do not have a drug plan, don't take part D. Instead approach the pharmaceutical companies and ask for an application for their PAP (patient assistance program) They all have one. By law they must give 20% of their profits back to the communities; and be prepared to show them your IRS return no matter how much money you have on it. They have different guidelines for helping than the government. They do not go by the poverty level, its based on a ratio of how much your drugs causes you a detriment in your life by paying them.
Let them deny you. DO NOT DENY YOURSELF the opportunity to be approved or denied by them. Let them make the decision. They have more experience than you do in these matters. So just go through the hoops (get someone to help you do it) and give them what they need when you apply.
Please note! If you have Medicare Part D, I was told that Pfizer will not help you at all (I was told this 9/25/06 by Pfizer's insurance department because they only help people who do not have any insurance plan at all).
Rebif's PAP phone number is 1-877-447-3243. Call and ask for an application. If you haven't filed a tax return all they require is a notarized statement of how much money you made last year.
Senator Levin in Michigan says that a bill is in the Senate to help us and the seniors with this "gap" in prescription coverage but I do not know how long this will take. Please call your Senators and ask him to revamp the Medicare prescription Part D.*
Thank you.
*Editor's Note: Since this essay was posted, a Medicare Prescription Drug Plan has been established. Check out the information here:
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