The Marginalized Patient

Do you want to know what makes me sick (no pun intended)?

The insurance company denied my Long Term Disability claim stating that there was not enough evidence to approve the claim. Therefore, I will effectively be terminated from my job this week–and lose my health insurance. The irony in the situation is that if I were to go apply for health insurance to cover me during my unemployment, they undoubtedly would deny me coverage based on the fact that there is evidence that I have a preexisting condition.

What in the world is wrong with this picture? The sick patient, who has already been thrown around the system–tossed from physician to physician, specialist to specialist, hospital to hospital–trying to get to the bottom of a complication health situation, has just been forced into the cracks– the cracks in the bottom of a broken system.

Basically, the marginalized patient is forced to:

  • get medical care dictated by insurance companies not by the world renown specialists that deal with their conditions daily
  • complete endless amounts of paperwork to claim, appeal, and fight for disability to cover medical and living expenses during their illness
     
  • focus more on red tape than healing

     

    We need to fix this problem.

6 Comments on “The Marginalized Patient

  1. Good thing there is obamacare to fix all this. You can get coverage with a preexisting condition. You should also get the COBRA insurance option.

  2. Sarah, I could be wrong but I believe denial based on pre-existing conditions is for people who have not have coverage during the diagnosis of that illness. You should definitely call around and ask. You are allowed to change insurance companies despite illnesses, they just don’t like it when you’re getting insurance for the first time to treat an illness. This doesn’t totally relate but I was denied maternity coverage (short-term) because of pregnany. What a load of crap. But anyway yeah I would definitely apply anyway just to see, before your current insurance runs out. It will be a pretty short phone call if they deny you (call and ask for a quote – you will get through to someone fairly quickly because they want to make the sale) and if you’re not denied, you’ll have coverage. You will likely be paying exorbitant rates though. From what I understand, the government denies all first-time applications for long term disability. Keep trying, I hear there is a much higher pass rate for second and third applications. It’s their way of weeding out the people who don’t need it. I’m sorry you’re going through all this. I know I’m far away but let me know if there’s some way I can help you.

    • Denial for pre-existing conditions also means you can’t change insurance companies, the logic being, you already have insurance so why might you want to change companies? The fact that you may be unable to afford COBRA is considered unimportant. It’s not a nice system, and it’s set up for well people who use it minimally, not sick people with actual needs.

  3. Been there… though I was able to get my LTD passed through fairly quickly- but for 3 months had no income, and wasn’t able to afford COBRA. Those premiums are outrageous. Find a social worker at a hospital or through your MD office- they can help with Medicaid paperwork. I was clueless; I’d been an RN for 19 years when I ended up on disability and had no idea how schizophrenic it is to be in need and unable to get help. At least on ‘Medicaid pending’ status, you have a better chance of not being outright denied MD care. Though some will since ‘pending’ isn’t a guarantee.

    I ended up having to file bankruptcy for purely medical expenses. There were no shopping trips or credit card bills- just medical costs.

    Xubex is a company that can help with medications. Their application form is simple.

    Keep applying for the LTD- if it is through your employer, YOU paid for it- but hurry, since once you are not employed by them, you no longer have the benefit- get a lawyer, as some employers do this on purpose.

    I feel for you. I remember those dark days of limbo. :/

  4. As posted on your kevinmd.com article –

    Having gone through this myself, it’s very disheartening indeed. What people don’t realize, however, is this IS easier to get through – provided you know how to “play by the rules”, so to speak.

    What you’re missing is hiring a Social Security Disability lawyer. I hired one after being denied, just like you, and he worked w/ me to get me approved for SSDI. I doubt the process would be any easier once 2014 rolls around for new SSDI applications, but for now, getting a lawyer that works in SSD law is THE way to go.

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