"No insurance, no job. S.S. Disability has turned him down. He's only 29, he's devastated."

[Hissyspit]

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=105&topic_id=9411071&mesg_id=9411071

"He's a good person with a kind heart. This shouldn't happen to anyone."

[CaliforniaPeggy]

1. Thank you for posting this here, my dear Hissyspit...

Perhaps someone in this forum will have some more good suggestions for his mom and him.

Highly recommended.

[Hissyspit]

2. I'm hoping so, too.

I know that you have to keep appealing with SSD. It's a game.

[CaliforniaPeggy]

3. I remember that being the case with ThomCat...

It took forever.

Horrifying, to have to fight for what is supposed to be a safety net.

[Enthusiast]

14. Imagine a future

without this precious safety net, as meager as it is. Gotta have war ya know.

[kath]

26. I've been thinking about ThomCat and wondering where he has been. Anyone know?

[DesertFlower]

4. yes. it is.

[Dr.Phool]

6. A friend of mine's son was turned down for 2 years.

They quit filing, and SS called them back about 6 months later, asking why they dropped their appeals. When they said it was useless, trying any more, they were told that it was standard procedure, and if he appealed one more time, he'd be granted a disability.

I'm on Railroad Retirement disability, and the situation is the opposite. They actually sit on the phone with you for a couple of hours, and make sure that you get everything right the first time. It took me less than 90 days.

[Fridays Child]

19. Standard procedure? To f**k with people whose health is already beat to a pulp?

Sometimes, my tears of frustration are outmatched only by tears of rage.

[DebJ]

24. Yep. My mom had to wait 3 years after being crushed top to

bottom in a car accident at the age of 60. At least the payments are back=dated to time of filing.

[Fridays Child]

25. Gawd, how awful.

I hope she's better, now. :(

[pitohui]

5. you always get turned down at first

i don't know what to tell you, i don't know anyone who got accepted for disability the first time, for most it took many years, esp. if they were under age 60

"it shouldn't happen to anyone" but in reality, it happens to EVERYONE in that situation, you just have to get a good lawyer and keep refusing to die...

[H2O Man]

23. Not always.

A person is likely to get temporary disability, based on their doctor's report; SSD benefits tend to have a higher rate for being rejected upon first application. In fact, though it's an unwritten policy, many times SS rejects a certain percentage of applications, without regard to substance. That percentage can be anywhere from 25%, 50%, 75%, and at times, 100%. Thus, the importance of contacting a qualified attorney to appeal the decision.

I do know, quite well, of numerous people who have gotten SSD upon first application. It certainly appears the person in question should have. But, as you correctly note, a rejection is reason to appeal. They go back to the date of the original application for benefits.

[pitohui]

36. i live in louisiana, NO ONE is accepted the first time, NO ONE

it's great that you know people who were accepted upon first application but in some states this is NOT the policy and it will NEVER happen

the point is, and i think we both agree here, NO ONE should give up after being refused the first time they apply, or even the second and third time -- you simply can't give up if you're disabled, you have no alternative anyway since you can't earn any more $, you can't just stop eating...

[hfojvt]

7. to me, you left the worst part out of your title

Without insurance and a job is one thing, but to have a severe debilitating disease at age 29 is another. Even with insurance and a job, this would still be awful "He's in extreme pain and nearly immobile."

That he was turned down for disability is not that outrageous if he had a typical case

https://health.google.com/health/ref/Ankylosing+spondylitis

"Prognosis

The course of the disease is unpredictable. Symptoms may come and go at any time. Most people are able to function unless the hips are severely involved."


"Most people are able to function ..."

it's horrifying that he was struck down in the prime of his life. Hopefully this will be true "Symptoms may come and go" and the symptoms will go.

[Hissyspit]

9. Yes, Friday's Child post was so upsetting, I had a hard time deciding what to put

into the subject line. I teared up when I first read her post, and I was just looking for fun, goofy stuff to read in the Lounge.

I'm would tell her that things are going to get worse before they get better, but they will get better, once they get a hold of the situation.

[Lasher]

11. Here's the drill:

You apply, you get turned down.

You get a lawyer.

You appeal, you get turned down.

You appeal again, you get approved.

That's the way it works.

[bobbolink]

18. And the lawyer gets a big chunk of your money!

That is soooo wrong!

People on disability need every cent that is due them.

One more ugly aspect of privatization!

[lonestarnot]

20. There's the racket.

[bobbolink]

29. Exactly. Racket, indeed. But, as you can see, there are those who think it is just fine.

40% of the money owed to a disabled person... poof!

BEcause we are determined as a nation to privatize everything.

[gratuitous]

22. Actually, the lawyer's fees are capped

The fee is a percentage of past due benefits, capped at (I think) $5,000 (used to be $4,000 when I worked for a lawyer in this field). The cap is reached after a pretty short time, so if a person is determined to have been disabled for six or seven years, and is owed back benefits for all that time, the lawyer's fee is the same as it would be if back benefits are awarded for the time it takes to reach the cap. Considering the length of time administrative appeals take, that time elapses rather quickly.

I strongly urge anyone who has had a disability application denied to keep trying, and to hire an attorney who is experienced in administrative law.

Here endeth the commercial.

[bobbolink]

28. Yes, I realize there are all sorts of rationales.... the fact is, this should be DONE in the

government office, should NOT be privatized to lawyers, and all the money due the person should be theirs to keep.

I don't see how anyone who wants justice for disabled people can argue with that.

[lonestarnot]

30. You are so right!

[wolfgangmo]

31. Hire a lawyer with what? Pocket lint?

I too have applied and been turned down, denied medical coverage I needed and was due, and have now lost my savings, my retirement funds and my sanity and I am still in constant pain.

I will take out only one more insurance policy. It will be a high term life policy. It will pay out in 2 years and a little bit after I put a bullet in my head. I'm borrowing the money from a friend who agrees with me that no one should have to live with this kind of pain. I'm not telling him what I'm borrowing it for - just that it is a sort of investment to get me out of debt. Some of you may note that I own a medical clinic but I can tell you that small community clinics are hurting big time if they are serious, as we are, about helping patients. My staff get paid and there is nothing left for me so I don't get a salary.

It will be my final fuck you to the insurance industry. At least my wife will be able ot go on with her life. I plan on taking out enough to pay off the mortgage, her student loans and still have about 500,000 left over to get her life back in order. I'm going to miss her. This pain, not so much. One asshole from the local church near where I live, when I told him about my pain had the nerve to tell me that I should get right with Jesus. Pretty big balls considering I was holding a shovel. As you can tell my pain levels are pretty high today - it tends to make me kind of irrational.

My point here is that to get a lawyer costs money which I don't have. If I had the time, energy or money to fight I would. I don't so the insurance companies win. The past 3 years have been a stuggle of constant pain, low energy, and trying to get enough money to see the doctor for one more prescription that doesn't work worth a fuck.

If it was up to me every person who worked for a private health insurance company above the level of file clerk would be rounded up before mass graves and then shot wholesale. It would be a service to the country. If you work for an insurance company and this offends you, and you have ever denied treatment, gathered evidence to deny treatment, or sold a "product" that you thought that just maybe might not the be the best thing to sell to someone in need, then fuck you too because I'm not apologizing for your contributions to the dehumanizing of America.

[gratuitous]

33. Back to what I said

Look to hire a lawyer experienced in administrative law. I can't speak for all attorneys, but an ethical administrative law attorney will advance the costs (which are mostly the filing fee in federal court, if your case goes that far, and it probably will) and there is no fee unless you win, and that comes out of past due benefits.

Yes, the whole thing is exhausting and draining, especially for persons who are already struggling with health concerns, both physical and mental. I will finish by saying that if you do nothing, your situation will surely not improve. If you consult with an attorney, it may improve. I'm not trying to push attorneys, or to provide legal advice, but if you want to PM me, I'd be happy to run down a list of questions you should consider asking should you change your mind about consulting an attorney.

[wolfgangmo]

35. And if the case isn't won?

Then I have taken on debt that I knew before hand that I could not reasonably expect to pay off. In my state that is a felony.

So either I take a chance and it might pay off, or it doesn't pay off and I go to jail, or I can follow through on my original plan and at least set my wife up with a chance at a happy life? I appreciate your advice and it seems sound, but I have no reason to expect that anything will improve here. I am now permanently disabled due to the delays I have suffered due to the quasi criminal activities of the insurance company. I say quasi because I am assured by my lawyer that what they have done to me is perfectly legal.

I've been told that I have been denied. I can't afford a lawyer and the ones I've called have told me that they won't take my case without a retainer which I don't have.

To paraphrase MC Hammer - It's bullet time!

[Fridays Child]

21. From your lips to the universe's ears.

Any remission, at all, would be wonderful. Unfortunately, the hip replacements will need to happen, in any case. I honestly don't even understand how he's mobile, at all, with a completely fused spine and a femur jutting into the pelvic cavity. Sometimes, I think it's only by virtue of sheer will, alone.

[CaliforniaPeggy]

8. And we wonder...

The military gets what they want. Right away.

While we ordinary citizens have to file appeal after appeal to get what we should have gotten right away.

Horrifying.

Disgusting.

Wrong.

:nuke: :grr: :nuke: :grr: :nuke:

[area51]

12. +1 (n/t)

[G_j]

10. ==

[Hissyspit]

13. kick nt

[theFrankFactor]

15. K&R

[Hissyspit]

16. .

[Hissyspit]

17. Update from FridaysChild:

"Gabrielle Giffords' office has made an inquiry in his case.

When I called his examiner, today, about a letter she sent me, she said that his case was the subject of a congressional inquiry. That means that Rep. Giffords has acted on my request for intervention. Oddly, though, her office never responded directly to me."

[midnight]

27. Here is some information that might help.

Right now, in 45 states across the country, insurance companies can discriminate against people based on their pre-existing conditions – leaving many Americans unable to get health insurance.
The Affordable Care Act creates a high-risk pool program to help adults who are uninsured and have a pre-existing condition get insurance as soon as possible. The program is a bridge to the health insurance exchanges that will be available in 2014.
Earlier this month, Secretary Sebelius sent a letter to states asking how each would like to participate in the high-risk pool program. The program was designed to give states the flexibility to carry out their own program, or have HHS do it for them. Specifically, states can:
Operate a new high risk pool alongside a current state high risk pool;
Establish a new high risk pool (in a state that does not currently have a high risk pool);
Build upon other existing coverage programs designed to cover high risk individuals;
Contract with a current HIPAA carrier of last resort or other carrier, to provide subsidized coverage for the eligible population; or
Do nothing, in which case HHS would carry out a coverage program in the state.
As a former Governor and State Insurance Commissioner, Secretary Sebelius understands the important role that states have in improving the health security of American families. Over the past several weeks, HHS has held several briefing calls and has been working individually with states to explain how the program will work and the different options for carrying out. Yesterday alone, over 350 people representing all 50 states, and Washington, D.C. participated in a call with HHS about implementation and the new high-risk pool program.
So far, 43 states have told HHS how they would like to participate; 28 have indicated they would like to run a high risk pool program, and 15 have said they would prefer that HHS administer the program for their residents.
Regardless of whether or how a state participates, the bottom line is that all Americans who meet the eligibility criteria will have the opportunity to join a high risk pool program.
More information on the high-risk pool can be found here.
Here’s a list of what states have decided as of 4:15 p.m. today:
States that intend to operate their own high-risk pool program:
Alaska
Arkansas
California
Colorado
Connecticut
District of Columbia
Illinois
Kansas
Kentucky
Maine
Maryland
Massachusetts
Michigan
Missouri
Montana
New Hampshire
New Jersey
New Mexico
New York
North Carolina
Ohio
Oklahoma
Pennsylvania
Rhode Island
South Dakota
Vermont
Washington State
Wisconsin

States that have elected to have HHS run the high-risk pool program:
Alabama
Delaware
Georgia
Hawaii
Idaho
Indiana
Louisiana
Minnesota
Mississippi
Nebraska
Nevada
South Carolina
Tennessee
Wyoming
Virginia http://www.healthreform.gov/forums/blog/blog_20100430.html

[wolfgangmo]

32. This is great - sort of.

But for guys who are self employed like me it does me no good. I make too much on paper to qualify for any programs. I've checked. But I make so little in reality that I can't afford to even see a doctor out of pocket very often.

For too many american's this is not a solution. What is happening with these high risk pools is that the insurance companies are being given an incentive to dump "high risk" patients and be absolved of their sins (to put it in biblical terms). There is a growing pool of American's for whom this will be useless. After they get dropped from the unemployment rolls, they will disappear - no money, no job, no home, no hope, and no health care.

We needed single payer, or at least a rational public option. We got the Insurance Company Profit for Life Act.

I'm glad it is helping some folks. I really am. And I hope it gets improved but I watch political trends. The G20 have just anounced world wide austerity measures which means that they are keeping tax cuts for the rich and corporate and cutting back drastically on social programs. So we will have this wonderful program, and it will end up gutted like a trout at a fish fry.

[G_j]

34. K