[sam101360]

Hi:

I stopped working due to my Lupus in November 2003. I didn't file disability until 2005 as I kept hoping I would get well enough to go back to work, which I'm still waiting for (lol).

I got the standard immediate denial, I got a lawyer, filed an appeal, waited, and got a second denial. We filed the next appeal for a court hearing and we have been waiting 16 months.

I was away and when I got home I got a letter from SSDI, here is what it says:

"As a result of our additional review, we are able to make a fully favorable medical decision and find that you meet the medical requirements for diability benefits. The onset of your disability is established as 11/2003. Therefore it is not necessary to have your case decided at the hearing level. We have not yet made a decision about whether you meet the non-medical requirements, but we will make that decision soon. You will soon get notice of your payments if you meet the non-medical requirements.

If you agree with our revised determination, you need to take no further action and your hearing request will be dismissed. If you disagree with our revised determination...."

OK so???? Did I get approved? What are the non-medical requirements? Is that time served (number of quarters worked? If so, didn't I have to meet them just to file?)

Any insight would be appreciated as I cannot contact anyone until Tuesday (Mon is a holiday in the US) and this worry will probably bring on a flare...LOL

Thanks so much - Stephanie

 

[Nutty]

Sorry I can't help you (I'm from Canada) but it definitely sounds like you are partially approved at this point.

As for the date (11/2003), I recently had to reapply to my insurance company for Long Term Disability and I was approved this time and they made it retroactive to the last day I worked. Hopefully, your insurance will do the same.

You mentioned..."Any insight would be appreciated as I cannot contact anyone until Tuesday (Mon is a holiday in the US) and this worry will probably bring on a flare...LOL""

That's exactly what happened to me. I got my notice that I was cut off from the insurance on my birthday and the next day I was at the emergency with pericarditis. That was at the end of May and I'm still paying it for it. After the pericarditis, I got this nauropathy and muscle weakness in my knees and thighs. I'm still not walking on my own.

All this to say...I hope you get your answers, and the risk of a flare is real! For me anyway!

Nutty

 

[Tom]

"As a result of our additional review, we are able to make a fully favorable medical decision and find that you meet the medical requirements for diability benefits. The onset of your disability is established as 11/2003. Therefore it is not necessary to have your case decided at the hearing level. We have not yet made a decision about whether you meet the non-medical requirements, but we will make that decision soon. You will soon get notice of your payments if you meet the non-medical requirements."

The way I read it, it basically looks like the decision has been made to approve your claim and that you proved your disability from 11-03'. The non-medical part is rest of the qualifying paperwork (Checking to see that you have not been working, that you've earned the 40 points required, how much back pay you are entitled to, etc.) then they will calculate your back pay and monthly payments. They may only go back 12 months from your file date on the back pay, but hopefully medicare will start right away. You will be getting a letter soon to explain everything above. Unless I missed something, I believe the letter is saying Congratulations! If you have direct deposit set up, you might start checking your balance. Some people get their back pay before they get the letter. 8)

 

[sam101360]

Tom:

Thanks! I kinda thought that might be the case, but I did not want to get my hopes up before the weekend was over...At least I wont agonize about it until Tuesday.

I really don't care how far back they go with the payments (my lawyer will probably try for the max if he has any say in it - LOL), my concern was my medical benefits. My husband had to come out of retirement to keep me covered, now he can relax again. He isn't old enough for Medcare, but he is well and can get private insurance for a reasonable amount.

Thanks so much!

P.S. Congrats on your win too! I hope they can adjust your disability date so that you can get medicare sooner.

Stephanie

 

[Pickles]

Congrats Stephanie,

I'm so glad you finally got approved. Tom is right, I think thats what it means too. Medicare isn't what its cracked up to be. They don't really pay that much. I have it and still pay Part A and B but I have a Medicare advantage plan that pays much more than medicare now. Most docs
do take medicare though so thats a good thing. Before I got approved for disability, I had great insurance that paid for practically everything then after I got approved, it went to medicare and they paid practically nothing. Its better now since I've got Humana.

Take Care and congrats again...BTW, If we ever got pregnant and I had a baby girl, her name would have been Stephanie Denise. Hubby's name is Steve and I've always loved that name, Stephanie. Our nephew is newly engaged and the finance's name is you guessed it....Stephanie.

 

[sam101360]

Pickles, Thanks!

My hubby has insurance that covers me for everything, I winder how Medicare will effect that. I will get a gap plan but was curious about partD that covers prescriptions..are we eligible for that as well?

I also asked under another thread how far back they will retro pay...

Thanks Stephanie

 

[Raglet]

Hi Stephanie

I have no clues about your system, but I hope they give you LOTS AND LOTS OF MONEY !!!!!!!!!

lotsa love

raglet

 

[lazylegs]

Hi Sam,

My husbands plan covers more than Medicare by far so I stayed with it. I still am covered by part A which is the hospital coverage that is free by Medicare.

The information is all online at :

http://www.medicare.gov/

Take care,
Lazylegs

 

[Maia]

Hi Stephanie,

Congratulations on your recent favorable judgment!

As to social security and presciption coverage and gap coverage and additional insurance to pay for what Medicare doesn't pay... good luck with all that! My parents just went through this as my mom retired this year & there were even rules about which months of the year she turned 65 that she "could" retire and get Medicare insurance immediately and which months she couldn't. Before she retired, she kept Dad on her insurance policy because it was cheaper and covered more things and a lot less hassle.

I would go into the SS office and talk to someone in person to try to figure out what would be the best for you in this situation. There are all sorts of rules to this and it's hard for anyone to figure it all out.

 

[Blue*Mist]

Hi Stephanie,
Medicare A,B and D are my only insurances and I'm grateful. BUT and its a big but... You have to be careful about what percentages they cover. My endocrinologist charges $210 per visit, (approx $40 x 3 visits a yr.) And I see a GP, Rheumy, Hematologist, all at least 3 times a year. Add in the my counselor weekly who I pay $20 plus Medicare contribution. Medicare covers only part of that and that is after you meet a yearly deductible. You may/will be billed for the 'rest' of the MD visits, labs, xrays etc. Provided the proper diagnosis is sent to Medicare and it is a 'covered' service...

Although Medicare is certainly better than no coverage, I think it is an sometimes impossible program to navigate and understand and I have a medical background...

If I were you, and I had to do this... I would try to make an in-person appt with your local SS office, write out your questions and sit down with them. The 800 number albeit, handy for routine questions, the reps read from scripts and cannot offer answers to unique questions.

I go nuts because if MD wants me to have a test, I ask them if it is covered by medicare, they say "I don't know", "call them". You call Medicare and they tell you they won't know if it is a covered service until they see the specific claim, then we can see if its covered, It drives me nuts, lately I've just done what the MD orders and deal with the bills later...
Good Luck with all of it.... just keep in mind that it is really is 'limited' coverage.

Med D is very helpful, and has low premiums (mine is $30 a month) some of my maint meds are 'free' if mail-away, other co-pays are low and some are $30, but I'm in what they call "gap" where I have to pay cash for all my meds until I spend $3000. Then I'm considered in 'catastrophic' level and meds are $10/15 copays.. My meds at the moment are $1400 cash a month.

So Sorry... :hehe: I meant for this post to help you, not be an account of my expenses.. :lol: :lol:

 

[sam101360]

Blue:

Thanks, I do understand the disadvantages of Medicare Part B and D. My parents are retired and we went through all of this when they went to medicare. I am looking into GAP coverage (Aetna I think), AARP has lots of information I need to study - I'm not old enough for them but the info is valid.

I of course will take the medicare, but will continue on my hasbands plan for as long as possible. He has been waiting to stop working for me to get coverage and SSDI, he would have kept working if I didn't get it.

Just waiting for all of the official information then I can get started on my research.

Thanks so much for the info.

Stephanie

 

[Blue*Mist]

I tried to buy gap insurance. I was told by several companies that I couldn't get it because I'm not 65... They told me you can't buy it if you just 'disabled' rude !! but I made my calls in Jan. 08.. maybe things have changed...
Good Luck..

 

[Clare.T]

Hello Stephanie

I too hope it means you are approved.

Hugs
Clare

 

[dudley]

Hi,

Congrats.

Please keep in mind that medicare does not kick in till 24 months or till the age of 65 (google it to verify..on strong pain meds). Also medicare only covers 80 percent of what they approve. Meaning doc may charge 1000 dollars. Medicare says that it is only should be 700 dollars and they will only pay 80 percent of that. Some docs do not even take medicare. Some will take medicare and eat the 20 percent but I have not run into a doc yet that will. I have additional insurance to cover the 20 %. Not cheap but in my situation it more than pays for it self.

Also you have to take into account your drug bills. Study what medicare provides. If your drugs are anything like mine you might also need addition insurance for that. Fortunatly in my state they cover all drugs that I am on with only a copay of 6 or 7 dollars because of my income. I just received a statement that so far my state has dished out over $14,000 in drug fees for me. Sorry for this info but I thought I would give you a heads up.

Elaine

 

[sam101360]

Elaine:

I have done some research, Aetna has a Medicare GAP plan that covers prescriptions, dental and eyeglasses. It is offered to disbaled persons regardless of age. They have several plans an most seem affordable, the one with no dental but no co-pays, no referrals, no donught hole, is about 425 a month for me (UNDER 50). The other plans vary in the cost and coverage but all estimate around 8200 per year of out of pocket (including premiums). They have a decent calculator that ask how many Dr visits, what meds, how many hospital stays, etc. so as to best match you with the plans.

I already met the eligiblity for medicare as I was approved with an onset date in November 2003.

Now I just continue waiting for the money and letter.

Thanks everyone!

Stephanie

 

[dudley]

I have medigap threw Blue Cross Blue Shield. It does not pay for glasses, dental or drugs. But it is great no copay. go to any doc that excepts medicare. In my state they have several programs for people on medicare. I pay 6 or 7 for drugs. I would look and see if your state has anything like it and if you qualify. I pay about 225 per month they variance is probably the drugs.

I see some of the bills that I dont pay. So far this year drugs have been over 14,000. Just one blood work was over a thousand. ER bills over a thousand.

With out secondary insurance I don't know what I would do.

Elaine