Medical documentation of your health condition and related impairments plays a central role in getting Social Security Disability (SSD) benefits. There is no doubt about it: You need your doctor’s help to win approval for your disability claim. However, you are on your own to pay for your doctor’s appointments, prescriptions, and other care. The only time the Social Security Administration (SSA) pays for you to see a doctor is if they need you to undergo a consultative medical exam to process your disability claim.
In most cases, you have to see a doctor and get regular medical care if you want to qualify for disability. You will likely need at least several months or more of regular medical care to qualify and proof your condition will last at least a year or lead to your death. Some conditions require an even longer period of care before you can qualify for benefits, depending on the impairment listing that applies to your diagnosis.
There are several ways you can get the medical care you need and the proper documentation of your impairment to qualify for disability benefits, even if you cannot afford to pay for regular visits to a doctor.
Are There State Programs for Low-Income Residents?
Every state has a medical assistance program for low-income qualifying residents. These programs offer access to the health services you need, including regular checkups and care for your condition. Pennsylvania’s program, HealthChoices, is generally available to those:
- Between the age of 21 and 64;
- Who have an income at or below the poverty level; and
- Meet specific immigration status requirements.
There are also some special programs for those with certain qualifying conditions. Contact your nearest county assistance office to find out if they offer financial assistance to residents with your specific medical condition and needs.
Can I Qualify for Assistance Through the Health Insurance Marketplace?
The Affordable Care Act, enacted in 2010, created an online marketplace that helps you find private insurance if you do not qualify for HealthChoices or other state or federal programs. Based on your income, you may be eligible for substantial subsidies to help you pay for your monthly premium. Some of the plans available through the marketplace have no deductibles and small co-pays.
Do I Have Other Options for Affording Medical Care?
You may have other ways to afford the medical care you need to qualify for disability benefits.
Income-Based Sliding Scale Clinics
Many areas have clinics that serve low-income patients, either using a sliding scale for costs or offering free or discounted services. There are a number of these clinics in and around Pittsburgh and Pennsylvania and one may be in your community.
All of these clinics cannot provide all services, though, so you will want to call ahead to ensure they can help you document your impairment for SSD purposes.
SSD Package Discounts
Sometimes full-service clinics or private practices will offer special pricing on packaged health services that document your condition specifically for your SSD application. While you will likely have to pay for these services, they may be at a discount.
State Hospitals and Health Centers
The Allegheny County Health Department offers some services at the Wilkinsburg Family Health Center. There are county- and state-funded clinics in other locations, as well. These facilities offer free and discounted medical services if you do not have access to insurance and meet their income qualifications.
Why Do I Need Medical Care Before I Can Apply for Disability?
Any of these options may help you to get the care you need to treat your health condition and to document your impairment as necessary to qualify for SSD programs. Your medical records, the documentation of your diagnosis and treatment, and the opinion of your doctor are necessary because they show the SSA you cannot work. This documentation allows them to determine if you meet one of their impairment listings, or if your condition leaves you unable to work. While there are other qualifications for SSD benefits, the most difficult one to prove is your impairment.
Berger and Green Can Help You Apply for SSD.
If you are seeing a doctor but need help getting the proper documentation for your disability claim, the disability attorneys at Berger and Green may be able to help. While we cannot fund your long-term care, we offer you some suggestions on how to get medical coverage so that you can see specialists and others who can help document your condition and improve your chances of approval. We can also help if you received a denial of benefits.