Patient not getting disability. Help!


(Dr Rob Lamberts) #1

I have a patient who has a severe neurological problem (multiple system atrophy) who has deteriorated in the past 2 years I’ve seen her. She apparently was able to get disability through Social Security, but only got the monthly checks from the government (about $1200). She did not, for some reason, get the Medicare that folks usually get. She’s a bit hard to understand due to the neurologic problem, so things are a bit vague. Apparently, we were told that she had to wait for 2 years to get any insurance. I need to give her some guidance on this. She ABSOLUTELY needs coverage to help her get the help she needs (PT, OT, neurology visits). Any thoughts? @philsq or other legally oriented folks?

(Dr Phil Eskew, DO, JD, MBA) #2

Hey Rob, I’m not sure what to tell you. If she is on federal disability then she should have Medicare. Maybe she did not have proper assistance and thus has Medicare Part A but does not have Part B because she forgot to sign up. The lack of part B would make it difficult for her to obtain the PT, OT, and neurology visits as you have described. I would find a navigator - this is exactly THEIR job. Another option might be to request assistance from one of the hospital administrators - they usually help with this because it tends to lead to paid bills rather than unpaid bills when you refer to their facilities. I doubt health sharing ministries would be helpful since they tend to exclude pre-existing conditions from coverage.

(Simplifi Benefits) #3

I am a little rusty on my disability rules but I believe the minimum waiting period to be eligible for Medicare is 24 months after SSDI approval versus date of disability. Unfortunately the special enrollment rules under ACA have really been tightened so the next time she could purchase individual health would be the Open enrollment for January 1. none of the health share would help and none of the short term medical plans would cover.

If she is not working she may be medicaid eligible - check for links to a lot of assistance programs.

Wish I had better news