Due to budgetary cutbacks and a general underfunding of indigent medical services, more claimants come to the disability process without current treatment for their impairments. We have previously discussed the availability of indigent care in Texas Counties. But individuals—due to various reasons—may not qualify for assistance. What do you do?
Document the denial: Never accept an oral notification of denial of services. The best practice is to submit an application and receive a written denial of services. This may not always be possible because some agencies pre-screen eligibility by telephone. At a minimum—write down where you called, the name of person with whom you spoke, the date of the conversation, and the reasons given for denying assistance.
If you have access to a physician, but you cannot afford recommended treatment, have your doctor write down the suggested treatment, the steps taken to obtain the treatment at low cost, and why it was denied. Ask for a copy of the statement; do not assume the doctor will place the information in your file.
Remember the closest services may be in the next county: Some agencies cover multiple counties and may not have an office where you live. This is particularly true with mental health care. Also, while a treatment center may be in your county, the administrative offices may not. Call the local office and ask where you may apply for services.
Ask for specialists: If you are admitted to a program, ask what happens if you need a specialist that is not located in your county. Under the Texas indigent care program, if your county does not provide certain types of specialists (for example, a cardiologist or oncologist), you may be able to receive services at a Regional Hospital at the county’s expense. If this is not available, please have it put in writing.
Apply for prescription assistance: While most pharmacies now offer low cost ($4/$10) prescriptions, even this gets expensive when you have multiple medications. And many medications are omitted from the list. Almost all prescription drug manufacturers have programs to offer their medications at little or even no cost. But you must apply, usually with the assistance of your physician. Again, it is necessary to document this process. Ask for a copy of the submitted application and ask for written confirmation of its approval or denial.
These steps may seem onerous, but in the current environment of higher denials from Administrative Law Judges, they are necessary and will help prove you have done everything you can to treat your disabilities. Let the experts at Morgan & Weisbrod give you more helpful advice on how to talk to your doctor about your impairments and how to diminish the drawbacks of sparse medical treatment records.
by Paul B. Burkhalter Managing Partner of Morgan & Weisbrod, Board Certified in Social Security Disability Law.