Tuesday, October 5, 2010

Too Sick to Work, Too Poor to Get Treatment…Breaking the Cycle

A common concern encountered when representing Claimants before Social Security, and in making the preparations to appear before the Administrative Law Judge, is gaps in the patient's medical treatment. As one might imagine, a Claimant gives their case the best chance of succeeding when there is a provable (and preferably multi-sourced) set of medical records that describes the patient’s debilitating condition in clear and rational detail over time. While cases without these features may succeed, and cases where these records exist may fail, treatment gaps not only are unhealthy for the seriously ill, but they also make claims for benefits more complex to navigate.

It is not difficult to imagine that such gaps would exist for someone who is unable to work (and earn money or have employee health benefits), especially if they are not blessed with supportive friends or family. Cases are even further complicated when the diagnosis is a medical condition that might possibly be mitigated by prescription medication. Social Security cannot force a Claimant to “be at their medically best” when seeking benefits, but not seeking treatment may plant the idea that a Claimant receiving treatment may not actually be disabled, which is clearly not a helpful proposition. So what can someone in this position do?

1. Contact local DFCS and Medical Providers

A meeting with their local DFCS would be in order. In addition to evaluating the Claimant for eligibility for other avenues that might provide health benefits, they will be able to suggest free or reduced cost clinics and prescription programs. Many cities have hospitals with Charity programs the Claimants should explore as well, and it is important to note that Federal Law (EMTALA) requires that hospitals evaluate and stabilize (if needed) patients that visit the Emergency Room, regardless of their ability to pay for treatment, so emergency care is always an option.

2. Contact the VA (if applicable)

If the Claimant is a Veteran, it would be advisable to discuss their options with a VA representative.

3. Discuss retroactive Medicaid with medical provider.

Finally, in Georgia (and other states as well), a Claimant or their Attorney can discuss with their medical providers the ability to retroactively file for payment through Medicaid once benefits are granted. If a specific set of steps are followed and the proper paperwork is filed starting at the time of treatment, a Medical Provider may secure payment for a patient that was otherwise self-pay, but who later secures Medicaid by way of their Social Security benefits. This is not a transparent process, but payment by Medicaid for services rendered may be secured well after the treatment is received.

The moral of the story is to consider all options when seeking treatment, and above all else, Claimants should take care of their health. The rest is incidental.

To discuss your Disability Case or Retroactive Georgia Medicaid Benefits with an experienced attorney, contact Thomas at Feiler & Associates.

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