I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Medicare/Insurance => Topic started by: kevinswife on April 11, 2012, 04:50:48 PM
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A doctor recently told me that it can take up to two years to receive Social Security Disability because 95% of the people are denied. I have some questions for those of you on SSDI:
1.) How long did it take to get approved?
2.) How long did it take to receive your first SSDI check?
3.) Were you denied SSDI? If so, did you appeal?
4.) Is it true that patients with End Stage Renal Disease cannot be denied?
5.) Did you hire a lawyer?
Thank you.
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1.) How long did it take to get approved? about 4-6 months
2.) How long did it take to receive your first SSDI check? about the same time frame as above.
3.) Were you denied SSDI? If so, did you appeal? no I wasn't.
4.) Is it true that patients with End Stage Renal Disease cannot be denied? I don't think that is true but not sure, maybe someone can answer this one better
5.) Did you hire a lawyer?
no
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If you have ESRD on dialysis, you shouldn't need a lawyer and it only took me two weeks to qualify once I had the dialysis Medicare admitting report from the dialysis social worker. If you are not yet on dialysis, then it may take a while, but you essentially automatically qualify for Medicare, SS and SSDI once you start dialysis as long as you have had enough qualifying work units (40 quarters).
You have permanent kidney failure and you receive maintenance dialysis or a kidney transplant and:
You are eligible for or receive monthly benefits under Social Security or the railroad retirement system; or
You have worked long enough in a Medicare-covered government job; or
You are the child or spouse (including a divorced spouse) of a worker (living or deceased) who has worked long enough under Social Security or in a Medicare-covered government job.
http://www.socialsecurity.gov/pubs/10043.html#a0=2
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I'm not on SSDI (yet) but have talked to SS and my social worker about it and also online research. It's a complex issue but I'm pretty sure of these:
- ESRD as evidenced by being on dialysis is on a list of diseases that get automatic approval
- the applicant cannot be working when APPLYING for SSDI
- even with automatic approval it can take 6-9 months for approval to come through
- once approved however, the SSDI payments are retroactive to the 1st day of the month when the applicant stopped working even if that was before applying (I think this is a sticky area if the time between quitting work and applying for SSDI is too long)
- once on SSDI you can make appx $800 per month MAX
- while on SSDI you can make an unlimited amount of money in any single month 9 times within the first 5 years as long as those months are not consecutive
This is just what I believe to be true based on my own research...you will have to contact SS to confirm everything. If you are on dialysis you may be lucky to get a competent social worker assigned to you who can help with these questions.
The big catch-22 for me is that I'd have to quit working then wait out that 6-9 months with no income. That's CRAZY. You can't work while the application is in process, but you CAN work after it's approved. Well, by then who would hire me even at $800/month? How would I live in the meantime?
:banghead;
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Here is another webpage showing the "presumptive" qualifying benefits for dialysis patients. Since the 1973 ESRD entitlement, ESRD is a presumptive diagnosis for Medicare and SSDI if you have the qualifying work units and have worked in the last 5 or 10 years. Even if you have worked and have enough quarters, you have to have recent work activity to qualify.
If you have all of those factors, ESRD is a presumptive diagnosis for Medicare and SSDI. SSI is only by income qualification. SSDI is only dependent on how much you have already put into the system with max amount around $2500.00. The average amount is about $1100.00.
http://www.disabilitysecrets.com/resources/social-security-disability/filing-for-social-security/presumptive-benefits.htm#b
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I had no trouble getting Social Security. I applied online and someone from the local office called me. After that I was approved although the payments didn't start for a few months. But there is Social Security and there is Supplemental Income. I didn't qualify for that since I had private disability insurance. I don't know how hard that is to get.
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I had no trouble getting Social Security. I applied online and someone from the local office called me. After that I was approved although the payments didn't start for a few months. But there is Social Security and there is Supplemental Income. I didn't qualify for that since I had private disability insurance. I don't know how hard that is to get.
SSDI is dependent on diagnosis and 100% documented disability. SSI is dependent on diagnosis, 100% disabled and income restrictions.
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1.) How long did it take to get approved? waited the six month period
2.) How long did it take to receive your first SSDI check? seventh month
3.) Were you denied SSDI? If so, did you appeal? was not denied
4.) Is it true that patients with End Stage Renal Disease cannot be denied? thats what I always heard, but not in all cases, make sure you have good documentation from the social worker and all the doctors, the more the better.
5.) Did you hire a lawyer? didnt need to
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Husband stopped work, called SS office and they set up appointment over phone. We did application over phone in Jan, was approved Feb. and received 1st check in August. He already had Medicare and his work insurance was secondary. Being he was on Medicare, I do thiink it made the Disability process alot eaiser since they are connected in some way. But not sure if Medicare is necessary to have when filing for disability.
The hardest thing in all of it was the not receiving income for the waiting period. It was not retroactive either!
If you have ESRD or F. and ARE NOT WORKING, yes at this present time, you are eligible for SSDI! If you have acute or some chance of regaining kidney function at all, they will deny/or approve you! Depends on your condition and your doctors notations in the filing!
lmunchkin
:kickstart;
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I work for SSA and will explain the rules a little in the context of your questions, just to give you an idea how the process works.
How long does it take to get approved? Approval time varies state to state. Nationwide I think the average is around 3-4 months, unless you are on medicare and you have the blue form from the dialysis center. Being on dialysis, having that form or being on Medicare already should make your decision a quick one - within 30 days. Key word is *should*. SSA does not make the medical decisions. Each state has a state agency, the Disability Determination Service which is in charge of obtaining and reviewing the medical records and making the decision. This is why the approval time varies state to state, and also why some states are "easier" to get approved in than other states.
How long does it take to get your first SSDI check? Well, that depends. Everyone who has worked enough, which for most people would be 5 out of the last 10 years can apply for SSDI. This benefit is based on your work and earnings and varies person to person. This program has a 5 month waiting period which everyone who is applying for the first time has to serve. This wait period starts with the first full month after the date of your onset. The date of onset is either the date you were diagnosed, started dialysis or stopped working. You cannot file with an onset date in the past if you've been working. If you have no income and no resources, you can apply at the same time for SSI which is a needs based program. Max payment is about $694 (can be higher in a few states that offer a state funded supplement) and that will go retro to the month after you file. If you apply for both and your SSDI benefit is higher, the SSI would stop when that benefit kicked in. You have to have limited income and less than $2000 in assets, including bank accounts, stocks, bonds 401ks etc ($3000 for a married couple) excluding the home you live in and one vehicle.
If you are denied for benefits, definitely appeal. But in my years with the agency I've not seen one person who was currently on dialysis and had that blue form from the center get denied. I am sure it probably does happen, but I've personally never seen it. The decision all hinges on the availability of medical records. You DO NOT need a doctor to say you are disabled. My SO's nephrologist doesn't consider my SO disabled, and told him flat out I won't write you a note like that. But it doesn't matter, the determination is based solely on the information contained in the medical records and if they meet the criteria listed in the disability rules (will post a link later)
As far as hiring a lawyer... if you have to appeal a medical denial, it is ultimately your choice. But here is how the process works - at the first level, the disability examiner requests records from the sources you list, and makes a determination. At the next level of appeal in most states, the reconsideration level, the case goes back to the same examiner office, but goes to a different examiner. If that is still denied, then it goes before an administrative law judge. You actually go to a hearing. And some people elect to get an attorney if they have to go to a hearing. But regardless what level you are at, the attorney still gets paid the same - 25% or $6000 whichever is less.
This is a link to the "Blue Book" which is what the disability examiners use to determine if your records show that you meet the criteria for disability.
http://www.socialsecurity.gov/disability/professionals/bluebook/6.00-Genito-Urinary-Adult.htm
Hope that helps!
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1.) How long did it take to get approved? 2 Months
2.) How long did it take to receive your first SSDI check? 4 Months
3.) Were you denied SSDI? If so, did you appeal? No
4.) Is it true that patients with End Stage Renal Disease cannot be denied? Do not know, but I had an underlinning illness that may have helped approval
5.) Did you hire a lawyer? No, just came as prepared as possible.
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My time frame was similar to Chris's. I did everything online. Then someone called to verify and have me give my doctors medical forms to fill out. 3 months from start to receiving first check. In fact, the first I knew I was approved was when I received a large check for back pay. They deemed me disabiled a year before I applied. No denial, no lawyers. There is a special law for ESRD and acceptance. Apparently someone's relative had kidney failure in the 50's and got this passed.
Look at the forms online. It really was an easy process for me. Good luck.
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I applied in 1999 tho, before computer website forms. I had to do t the old fashion way of walking in, wait my turn :rofl;
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I know this is a little late, but just thought I would add my two cents.
The 1st step of the application process in the initial application. Typically takes 3-6 months to get a decision on the that. About 2/3 of these are denied. You have the best chance of being approved for benefits at the hearing stage. An attorney is very helpful at this stage as they will be able to argue your case in front of the ALJ. About 58% of hearings are approved nationally.
More info on determining how much money you can get from SSD: http://www.socialsecuritydisability.tv/how-to/how-to-determine-how-much-money-you-will-receive-from-social-security-disability (http://www.socialsecuritydisability.tv/how-to/how-to-determine-how-much-money-you-will-receive-from-social-security-disability)