Your Guide To The Disability Process

Your Guide To The Disability Process

The Patient Advocate Foundation is a national non-profit organization that serves as an active liaison between the patient and their insurer, employer and/or creditors to resolve insurance, job retention, and/or debt crisis matters relative to their diagnosis through case managers and attorneys. Patient Advocate Foundation seeks to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their financial stability.

Patient Advocate Foundation offers direct patient services through our toll-free number and website.

National Toll-Free Number: 1 (800) 532-5274 Phone Number: (757) 873-6668 700 Thimble Shoals Blvd. Suite 200 Newport News, VA 23606 Fax: (757) 873-8999 E-mail: info@ Internet:

First Edition, ?2004 Patient Advocate Foundation.

All rights reserved, including the right of reproduction in whole or in part in any form.

Manufactured in the United States of America.

Your Guide To The Disability Process

ACKNOWLEDGEMENTS

Your Guide to the Disability Process has been prepared by the Patient Advocate Foundation, a national network for healthcare reform and patient services located in Hampton, Virginia.

Patient Advocate Foundation would like to acknowledge the U.S. Department of Labor, the Social Security Administration and the Centers for Medicare and Medicaid for providing guidance through local and national resources, websites and publications. The following resources provided invaluable information for this publication:

U.S. Department of Labor, "Compliance Guide to the Family Medical Leave Act", Social Security Administration "Understanding the Benefits"; "Disability Benefits"; and "Medicare",

Centers for Medicare and Medicaid, "Medicare and Other Health Benefits: Your Guide to Who Pays First";

and The Patient Advocate Foundation's "National Financial Resource Guide"; "The Managed Care Answer Guide, Second Edition 2004"; "Your Guide to the Appeals Process"; "Greater Understanding Brochure Series";



Nancy Davenport-Ennis, Editor President and CEO Patient Advocate Foundation and National Patient Advocate Foundation

Principal Writing:

Contributing Writer:

Beth Darnley, Executive Vice President, Patient and Public Relations Patient Advocate Foundation

Sandy Shook, LPN Senior Case Manager, Director Internet Patient Services Patient Advocate Foundation

Jennifer Risk, BA Sociology Manager of Regional Operations & In House Education Patient Advocate Foundation

Marianne Smith, Esq.

Contributing Researcher: Erin Moaratty Senior Case Manager Patient Advocate Foundation

Contributing Editors:

Jacqueline Beard, BA Social Work Case Manager Patient Advocate Foundation

Donna McQuistian, RN, OCN Vice President of Patient Services Patient Advocate Foundation

Deirdre O'Reilly Marblestone, Esq. Legal Case Manager Patient Advocate Foundation

Aaron Marshall Executive Vice President of Informational Technology Patient Advocate Foundation

Greg Baker Web Development Manager Patient Advocate Foundation

TABLE OF CONTENTS

Introduction ...................................................................................................................................... 6 Chapter 1 - Short Term and Long Term Disability ............................................................................ 7 Chapter 2 - Social Security Disability ...............................................................................................10 Chapter 3 - Health Insurance Issues Before and After Medicare ........................................................13 Chapter 4 - The Appeals Process .................................................................................................... 20 Chapter 5 - Financial Assistance ..................................................................................................... 22 Important Numbers......................................................................................................................... 27 Bibliography........................................................................................................................ 31

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DISABILITY ENTITLEMENTS TIMELINE (UNINSURED)

Date of Diagnosis or out of work 1 week 2 weeks 45 days 2 months

? File FMLA with employer if applicable

? Complete physician visits and follow ups ? Gather medical and financial documents ? Apply for indigent drug programs

File for Medicaid, Social Security Disability Benefits and Social Services assistance

? Uninsured patients check status of Social Security Disability Benefits and Medicaid applications

? Contact PAF if denied or no response

Expedited SSI payments for terminally ill patients may begin

3 months 5 months 12 months 29 months

FMLA protection ends

SSDI waiting period ends for approved patients and payments begin *24 month Medicare waiting period begins

Must have medical certification of disability that prevents patient from working for 12 consecutive months to qualify for Social Security Disability

SSDI recipients become eligible for Medicare

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DISABILITY ENTITLEMENTS TIMELINE (INSURED)

If "deemed" disabled by SSA within the first 60 days of COBRA, patient is eligible for 11 month extension of coverage.

Date of Diagnosis or out of work

1 week 2 weeks 45 days 2 months 3 months 5 months 12 months 18 months 24 months 29 months 36 months

? Check insurance policies for providers and benefits ? File FMLA with employer ? File STD application ? COBRA may be offered

? Complete physician visits and follow ups ? Gather medical and financial documents

? Most STD payments begin ? Apply for Social Security Disability benefits

? COBRA election due if eligible ? Check status of Social Security Disability application ? Contact PAF if claim denied

? Notify insurer of COBRA extension ? File LTD application

FMLA protection ends LTD payments may begin

SSDI waiting period ends for approved patients and payments begin *24 month Medicare waiting period begins

Must have medical certification of disability that prevents patient from working for 12 consecutive months to qualify for Social Security Disability

COBRA ends unless eligible for extension

LTD ends for certain diagnoses

SSDI recipients become eligible for Medicare and need to choose a Medi-Gap plan

COBRA extension ends

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INTRODUCTION

This guide was written in response to the many issues that have been identified by the Patient Advocate Foundation, as they have assisted patients who were faced with disabilities and subsequent access difficulties. Many of those patients would have benefited from the information contained in a comprehensive guide to navigating the overwhelming process of filing for Disability benefits. Whether you are filing a claim through an insurance policy or through the Social Security Administration, the process is rife with red tape and confusion. PAF feels that the more information you have, the more capable you will be to make decisions that can ultimately impact your long-term insurability and financial stability. It is our hope that Your Guide to the Disability Process will provide you with the necessary tools to anticipate the steps you need to take to make your disability claim problem free. There are five chapters in Your Guide to the Disability Process:

Chapter 1 ? Short Term and Long Term Disability This chapter describes the differences between Short Term and Long Term policies and how to understand how they work and what you need to do maximize your benefits.

Chapter 2 ? Social Security Disability This chapter describes the Social Security Disability process and the difference between the programs offered by Social Security. Tips on filing and what you need to do are included.

Chapter 3 ? Health Insurance Issues Before and After Medicare This chapter explains Medicare and Medicaid eligibility issues disabled patients often have. It also contains guidance for disabled patients enrolled in group health insurance programs.

Chapter 4 ? Appeals Process This chapter addresses the process through which you can file an appeal should your claim be denied.

Chapter 5 ? Financial Resources This chapter lists resources that can assist disabled patients with health care alternatives and financial assistance.

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