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My Claim was Denied and I Have Some Questions

Discussion in 'Social Security / Disability Benefits' started by suebehar, Mar 16, 2008.

  1. suebehar

    suebehar Registered

    As I expected (but still had every digit crossed), my Social Security Disability claim was denied. I'm working with a company called Allsup and they will assist me with the appeal.

    What has me in a constant panic is medical insurance. I am currently on Cobra and have about 8 months left from my first 18 months.

    In California, I think there is an extension for another 18 months. Does anyone know how that extenion works; how I apply for it and how the Cobra fees would be calculated?

    And then what happens if I continue to get denied by SSD and all my Cobra options are gone?? I am beginning to stockpile medications, because my prescriptions will be impossible to pay. My co-pay monthly is $300. I will never be able to afford full-price prescriptions. I think all this has contribued to a very severe flare. Every symptom is in full force.

    I continue to receive Long Term disability income from Cigna (my former employer offered this coverage), but I will still never be able to afford my healthcare, which will eliminate the meger quality of life and income I have now.

    Any ideas on how to get through this stressful process would be so appreciated. I'm going to be 55 in May, so I have too many years left before I am age eligible for assistance.

    Thank you all!

  2. Maia

    Maia Registered

    I don't know the answer to your question as to how long COBRA can be extended. I imagine with your LTD money you may make too much to qualify for Medicaid? I would be stockpiling medications in your shoes too! The drug companies do have programs in place to provide free medicine to people who need it, in many cases you just have to have your doctor fill out the forms for you verifying that you are unable to pay for them but still need them. My other suggestion would be to contact the hosptial medical social worker department and see if they have any suggestions for you. They usually know every thing, locally and nationally, that can help people in situations similar to yours. And if they don't, they'll find out. Very helpful people!

    I have also been on LTD for 2 years now, and my LTD company has me working with ALLSUP as well to get SSD. My initial claim was also denied in the last month or so but ALLSUP is of course moving on to the appeals process. The person I talked to said that over 90% of the approvals they get come at the 2nd APPEAL or later. Often it goes right up to the judge/court hearing stage. So, chances are good you may still get approved, and the 2 year wait you have to endure to get medicare health insurance is usually done with by the time you get approved.

    I am fortunate to have medical coverage through my husband's work still, but if anything happened to him I would be in serious trouble with respect to insurance. Good luck with everything.
  3. sam101360

    sam101360 Registered


    I too was denied, did the administrative appeal and was denied again, I am now waiting for a hearing date (6 weeks so far, expect 6 months or more for a date).

    I have had a lawyer since the first denial. I have a great Dr who will complete the RFC form for SSDI, and will testify at my trial (for a small fee).

    I have medical through my husband, but he wants to retire and cannot do this until I have disability and medicare. We have too much money and assets to qualify for any of the programs - medicaid or free drug programs.

    Good luck in your endeavors and I hope you both get approved!

  4. suebehar

    suebehar Registered

    Thank you for your replies

    Maia and Sam, thank you both for your information and support. I'm trying to not let the process overwhelm me, but the thought of having Lupus, RA and Sjogrens without medical insurance is enough to push me totally over the ever present edge.

    My best to both of you, and thank you again.

  5. Jirel

    Jirel Registered

    Susan, all my best to you. I hope you are going in for an immediate appeal.

    Please, may I selfishly ask you to keep us updated on your progress? I have LTD through my company and in my last flare (lasted 5 months) I almost quit to go on disability. I know its comming and I have been wondering what the process will be like. Your experience could give me so much information, it would help me immensely. Yes, I'm planing on it taking 2 - 3 years to get SSI disability, but it sounds like you had no problems with the long term? If I knew I could get my long term right away I would worry less. Its a lot higher than SSI - yes, I know it doesn't include medical insurance, but at least I would have income while trying to get SSI, and I know they would be pushing for the filing so they could get their money back.

    PS - is anyone willing to tell me what LTD company they have? I have only Lupus, non organ involved. But I DO have major back problems as well.
  6. Maia

    Maia Registered

    I have Principal. I would be happy to communicate with you over the process I went through - just PM me with any questions you have.
  7. suebehar

    suebehar Registered

    Jirel, my LTD carrier is Cigna. While I was on short term disability, it was difficult dealing with them. They kept losing my information, said they didn't receive faxes from myself or my doctors, and generally made it very stressful. I finally had to have my employer become involved. Once I did that, things seemed to proceed better. After six months, they forwarded my claim to LTD, and things greatly improved. They no longer have buried me with repetitive paperwork and are more responsive.

    Feel free to email me with any questions you might have. I will keep posting my progress.
  8. Jirel

    Jirel Registered

    Maia and Suebehar, thanks. I will pm you guys when I can. You know how that goes. :) I'm still working right now so my involvement is rather sporatic.
  9. Jenkay

    Jenkay Jen

    Just to join the chat... I too just started on LTD with Cigna who has me working with Allsup on my first filing for SSD. It has been such a ride.

    Has anyone had trouble keeping there LTD when they get to the two year mark. I know I have to meet a new definition at that point.

  10. Maia

    Maia Registered

    Just this month was my two year mark, and I was required by my LTD company to see a doctor for an outside opinion on my ability to work as part of their "review" process to determine if I would continue to receive benefits. In my case, I was approved. I'm not sure why, no one ever explains these things to you. It was a scary time until I found out their answer was to keep me on it.
  11. raggedyann1

    raggedyann1 Registered


    I don't know how I missed your post before today. There is a post at the top of this forum where I try and explain the Cobra and Hippa laws. Your cobra will extend to 29 months since your qualifying event is disability. 29 months is the length of time it takes for Medicare to start from the initial disability date. Cal-Cobra is for employees of small companies in the state of California, firms with 2-19 people, as they are not covered under Federal Cobra law.

    I hope you have been collecting State Disability for the past 10 months. That will only run for 12 months but it is tax free income.

    If you reach the point that you still are not receiving SSDI at the end of Cobra you can purchase HIPPA Insurance it isn;t cheap but you have 63 days from the end of Cobra to purchase the insurance.

    Hopefully your appeals process will be finished before you reach that point. You can order refills on prescriptions up to 7 days early on a monthly prescription and 2-3 weeks early on 90 day fills. You can finagle this to increase your meds on hand for any change over. I do this with my Medicare part D as I go into Catastrophic coverage each year and the early part of each year the meds are expensive for me so I stock-pile the brand name meds to try and stretch out the finacial pain a little.

    I hope this all makes sense. Please feel free to keep asking questions.

    Hang in there,
  12. Jenkay

    Jenkay Jen

    Thanks for the info Maia!
  13. Jirel

    Jirel Registered

    Well, although Cigna is my health insurance, Unum is my LTD insurance carrier. So no help there in making me more comfortable with the process. :) On the other hand, I keep telling myself I should be happy I can still work and make more money, and I know I should. Its just that some days I don't want to deal with all any more - although how I think having to deal with no money would be better.... sigh.
  14. aurianna

    aurianna Guest

    don't give up

    My mother has fought since 2003 to get me on disability Make sure the doctor documents every ache and pain. Make sure you document any changes that affect your life. Have all bloodwork, psychologist visits, physical therapy, etc sent to disability claim office. This will help.
  15. dudley

    dudley Registered

    Hi, sorry about yuor predicament but I understand because I was there. I went through even cent to keep medical insurance. Once you lose it will take 12 months to get insurance on pre-existing conditions insurance. Please read the following by raggedyann1. It might help.

    I wish I had know this info back when.
    HIPPA and Cobra Stuff

    Also look for info on this site and google.

    Best of luck

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