Hospitals today have an extremely diverse patient populations, especially when it comes to disabilities. Case managers, social workers and other patient advocates must navigate an increasingly complex system to determine if a patient’s condition is severe enough – or will become severe enough – to qualify for Social Security Disability Insurance (SSDI) benefits. You rarely have ample time or information to properly assess their condition before discharge. Too often, that same patient will return months or even years later to be readmitted – this time without health insurance, unable to pay for his or her treatment.
This scenario often can be avoided if healthcare professionals encourage patients to consider applying for SSDI benefits. Congress created the SSDI program in 1956 to protect Americans who became disabled and could no longer work. SSDI beneficiaries become eligible for Medicare after a waiting period, so even though they are out of work and still sick, they receive medical coverage.
The challenge now facing the SSDI system is that the population of Americans with disabilities is growing rapidly, in part due to the aging baby boomers, putting enormous strain on workers who review claims and make benefit determinations. Many applicants wait months or even years to find out if they qualify.
That’s why disability representatives are working to raise awareness of the challenges involved in successfully filing for federal disability benefits. My organization, Allsup, helps individuals get through the disability review process more quickly so they can receive income and come a step closer to Medicare eligibility. We work with hospitals and healthcare facilities to support their patients, without contracts and at no cost to their organizations. We also offer continuing education to healthcare providers, again at no cost, to equip patient advocates with the information their patients need to determine if their condition is eligible for benefits.
Healthcare professionals often are the first people patients turn to for advice. As a result, we have developed a list of top 10 tips that we encourage you to share:
- Determine eligibility. Claimants must have been disabled before reaching full retirement age (65-67) and meet the Social Security Administration's definition of disabled, which generally means being unable to work due to a medically determinable mental or physical impairment expected to result in death or last for at least 12 months. Applicants must have worked and paid into the program for five of the last 10 years.
- File immediately. If an initial claim is denied, the wait for an appeals hearing now takes an average of 371 days. There is no time to lose.
- Obtain doctor's agreement. Claimants need written medical confirmation of their qualifying conditions when they apply. Otherwise, they may face delays.
- Get help. Filing for disability benefits is a complicated process akin to preparing a difficult income tax return. The earlier applicants seek help, the more support they have to put them on the right track.
- Prepare an accurate medical record. A comprehensive factual record is required to prove your disability.
- Establish work history. Compile records of dates and tenure of previous employment. Individuals must have worked five of the previous 10 years to qualify for benefits.
- Meet deadlines. If benefits are denied at any stage, claimants have only 60 days to file an appeal. If the deadline is missed, the process starts over from the beginning.
- Reduce spending. The long wait for benefits means that people lose their savings, cars and sometimes homes. Cut out unnecessary spending as quickly as possible and prepare for the long haul.
- Maintain health insurance. There will be a temptation to cut spending on insurance, but even after individuals begin receiving disability benefits there is a two-year waiting period for Medicare eligibility.
- Don't give up. The Social Security Administration denies more than 60 percent of all initial applications, but two-thirds of the people who appeal eventually will receive their benefits.
Karen Hercules-Doerr is national sales director, consumer sales and marketing, at Allsup, which has helped more than 150,000 people receive Social Security Disability Insurance and Medicare benefits since 1984.
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