[thinker22]

Hi guys,

I know I've not been on in a while. I was severely depressed since last October when the mania ended. A few weeks ago I started to feel better on a new medication combo/dosage. Then yesterday in the mail I get a denial letter for both social security disability insurance and supplemental income.

They said bizarre things like, "There are plenty of jobs you can work with your age and experience in the national economy." They totally didn't read my file. It doesn't matter what the job is, I can only focus to work 5-7 hours a week or two days of 4 hours a week. Even that is excruciating. I'm so exhausted after I work I can't do anything. It's like they're punishing me for working hard at being semi–functional.

Here's the issue. If I don't appeal and eventually get SSDI (at very least), I lose my state insurance plan that pays for my medications and hospital visits, etc. If I don't get my medications (which cost around $2,000 a month), I will be in the hospital on a regular basis and go bankrupt. So the state will end up paying anyway.

How do I get that through to them in a non-threatening way in my appeal letter?

Also, does anyone have experience with winning an appeal? How did you do it?

Thanks for your help. I'm so bewildered.

[BNLsMOM]

Hi Thinker. I am happy to see you back on the board. i don't have a good answer to your appeal question, but when i applied, i got accepted. I think it is because I wrote everything specifically about how my condition affected my work throughout my whold life even when i was undiagnosed. I think I remember you have been hospitalized. (??) I wrote a lot about how i was hospitalized and I need time to recover from that. I also have a great therapist on my side who was willing to write a letter highlighting all the negatives that I am facing. he let me read the letter and then reassured me that there are many things going right for me in life and that he just wants it to look good for the SSDI application. I don't qualify for SSI because I have some savings and my husband makes too much.

Between my spotty work history and my T, I think it all came together.

I have also heard that an attorney can help quite a bit.

I missed you around here.

[perpetuallysad]

I wrote explicitly about me and everything that happens to me, as did my t/pdoc (who strongly believes I should be on disability) during my initial application and my appeal. I have a terrible work history (not being able to stay one place long). I got denied both times. I have a little less than 30 days to do my last, before a judge, appeal. I don't think it has much to do with what you write, or what you pdoc says, its very arbitrary and is decided on a state level by a state worker. So, depending on your state and how willing the people are to try to understand is how its decided. Sorry to sound so pessimistic, I want to be positive, but this has been a devestating and extremely invalidating experience for me. They keep telling me I could be a cashier in this national economy. Whatever, they clearly don't understand what it means to not physically be able to make yourself leave your house.
I'm working on getting the courage up to talk to a lawyer.

[thinker22]

I've heard all kinds of stories. And thanks you guys for mentioning your experiences. It seems like some people get accepted on their first try, but most do not. The appeals process sounds like appealing a denial that your insurance company makes and getting denied over and over again without good reasons. They make stuff up or read only what they're looking for to find a way to boot you out, rather than the vast majority of evidence.

I guess all I can do is to try. The state can't cut my disability insurance unless I stop the appeals process. I'm going to work on the appeal this weekend. Try to get the salient points across in a factual, yet dire way.

Like: I need this because...If I am denied, this is what happens...I am disabled, but I work as hard as I can to leave the house one day a week, but I can't do more, etc. It really is a domino effect. I'll lose everything if they continue to deny me.

If I don't have my meds, I can't go to school or work at all. Then I would be destitute and I'd also be in the hospital. And they'd be paying so much more. This is nuts.

[Anneinside]

I am on SSD and medicare. Medicare Part D is the medicine part but has what they call the doughnut hole. After you and the insurance have paid of total of about $2500 then you have to pay the next $4000. The last time I was in the doughnut hole I had to charge my meds. I am still paying the credit card off. This year I have more expensive supplemental insurance but no doughnut hole so I have a chance of getting rid of my credit card bill. The doughnut hole is another case of the government wanting to save money which can actually cost more. If I hadn't had a credit card I would have had to go without medication and I would have ended up in the hospital which would be covered!

[perpetuallysad]

It is nuts thinker, and a very messed up process. I guess some people may want to be on disability for fun or something, but I cannot imagine why exactly. Its not like they give you tons of money or anything. But, when you have no other thing to resort to, it is there to help. It seems like if you can produce years of medical evidence of a clear problem that it should be cut and dried. Who knows why they do what they do. I really hope you get accepted. Are you going to try to get a lawyer? I am so scared of that.

[thinker22]

I did the online appeal today. It took me about 3 hours. I wanted to get it out of the way because I was spending all day and night worrying about it. Probably will get denied again, but at least I made my point about needing the insurance to get my meds stay out of the hospital. I also told about how the medication side effects (such as Geodon causing me to faint), makes normal functioning difficult. Maybe they'll actually read instead of jumping to conclusions, but I doubt it.

Now I'm worried about that donut hole thing. I'm not sure if my state insurance has it. I guess I'm not up to the maximum if they do. I started getting meds through them in October of '09. My meds are very expensive and I'm on 5 different ones.

If I get denied again, I am getting an attorney who specializes in this sort of thing. I can't afford to give up.

Thanks for your support.

[grizmom]

Hi...I just found this group, and this topic hit home with me...I am on disability, but I was denied twice and then my family helped me get a lawyer and I was finally accepted, and have been on disability since 1995. After my first appeal was denied, I filed another appeal (with the lawyer) and had to go to a "hearing" (it was held in a hotel conference room, not in a court). I found out there that one of the main reasons I had been denied was because of the findings of the Department of Vocational Rehabilitation...they said I was "too smart" and that with my intelligence I should have no problem holding a job. The judge got REALLY mad and told the DVR guy to sit down and then lectured him, saying that I could not use my intelligence if my emotional problems prevented me from leading a "normal" life. The judge then appologized to me for the previous denials and said that with my doctor's and therapist's letters and the finding of their independant psychiatric evaluation that I should have been approved with my initial application. He gave me 3 years back pay, which is unusual. I thought maybe my story would give you some hope...don't give up! If you can't work and you have proof from your own docs and therapists, then you will most likely get accepted eventually. Good luck!

~J.J.

[Anneinside]

Thinker, the doughnut hole only applies to medicare, not state insurance. Sorry to have worried you. I guess I was venting about my own situation.

[thinker22]

No worries.

[HelplessHope]

Originally Posted by thinker22

Hi guys,

I know I've not been on in a while. I was severely depressed since last October when the mania ended. A few weeks ago I started to feel better on a new medication combo/dosage. Then yesterday in the mail I get a denial letter for both social security disability insurance and supplemental income.

They said bizarre things like, "There are plenty of jobs you can work with your age and experience in the national economy." They totally didn't read my file. It doesn't matter what the job is, I can only focus to work 5-7 hours a week or two days of 4 hours a week. Even that is excruciating. I'm so exhausted after I work I can't do anything. It's like they're punishing me for working hard at being semi–functional.

Here's the issue. If I don't appeal and eventually get SSDI (at very least), I lose my state insurance plan that pays for my medications and hospital visits, etc. If I don't get my medications (which cost around $2,000 a month), I will be in the hospital on a regular basis and go bankrupt. So the state will end up paying anyway.

How do I get that through to them in a non-threatening way in my appeal letter?

Also, does anyone have experience with winning an appeal? Hodid you do it?

Thanks for your help. I'm so bewildered.

Hey there,I read your post and I'm basically in the same predicament you are except I think I'm further into the process than you are.I was denied three times and now I'm awaiting a trial hearing.I talked to an attorney last week to see if he could help me with my case and he told me my case wasn't severe enough for him to take!Ridiculous!If these people only knew how screwed up my mind is day in and day out.I long for a normal healthy functioning mind,but I just unfortunately don't have one.My medical insurance will run out this year too,in June and then I'm really screwed too.I don't know what I'm going to do.

[thinker22]

Sorry to hear about your predicament HelplessHope. Some of the things you and grizmom have mentioned make me think of the problems I am having and will have in this process.

They all but told me I was too intelligent to have a true disability. Like I should just take another job with more hours. My current job would let me work more hours if I were able to. I just can't focus and I have physical problems caused by my meds. In my appeal I stated that it's really hard to do much of anything, even leave your house, when there's a voice in your head telling you it's going to kill you. Now what does that have to do with my being smart? It's crippling no matter what your IQ is. Without my meds I'd hear it constantly, as I was just back in early February and all of January.

They're dumb. If I can work part time, I don't have to rely as much on the gov and other people. But if they don't cover my meds and my docs, I'll earn nothing and be in the hospital all the time. Who's going to pay for that? Not me. I'm broke.

It may be hard to find a lawyer who will take my case too, but I have to try. The most difficult thing about being mentally/emotionally disabled is they can't point to an external wound so it's one person's word against another. My doctors all vouched for my disability, but they decided they knew better than them. Some office worker who is paid to deny everyone and see if they will go away. I doubt they even read anything in my file. They just waited 6 months and sent a denial form letter listing the names of the doctors I have been seeing, but not reading their reports at all.

Sorry to sound cynical, but they remind me of the commercial insurance cartel. Deny first and see if people are persistent enough to take them to court. Who knows. Hang in there everyone.

[RRU96]

Well... thanks for even talking about SSI and SSDI. I have only been Dx'ed for 2 years.... but have not yet thought about applying. It is something that affected my life well before I was diagnosed, but I just dont know what to do. Circumstances on every case is different.

In the meantime, I wanted to ask if you have tried any kind of Patient Assistance. The greatest place to start in needing medications is the drug company themselves. For instance, I am also on Geodon, so I went online the other day to the Pfizer website and was able to download their Patient Assistance form. If you cant find it, you can also probably give them a call and have one mailed out. These PA forms are extremely helpful, the problem is some Dr.s dont want to fill them out. So fill out everything possible that you can. This helps your Doc by making it quick for him, and it prevents his/her office from charging you to do paperwork.

Nearly EVERY medication is available for Patient Assistance. And, just because you make X amount of money, doesnt mean that you can't get assistance. Simply do a search for your medication to find out the Name Brand Manufacturer. e.g.

I am also on Fluoxetine. I need to find out the NAME brand, which is Prozac. The maker of Prozac is Lilly. So then I did a search for Lilly Pharmaceuticals and once on there site, I did a search for Patient Assistance.

This seems like it may benefit a few people on here. If anyone needs any help, I may try and go through some of the more popular medications and find patient assistance forms. For most medications, they cannot be sent to your home. You will get them shipped usually straight to the prescribing Drs office.

I wish you luck in your appeal. And never let getting your meds be a decision you have to make.

[thinker22]

Thanks RRU96. You have a point. I have been on patient assistant programs in the past. Because the state considers me disabled, though, I have their insurance which pays for all my meds. However, if I lose my SSDI battle, the state drops me, then I would need to go back on patient assist. I had forgot about that option, so it does ease my mind a bit.

[RRU96]

Well I have been thinking about making an entire list to access patient assitance forms. I have been on the fence about spending the time working on it... But seeing that people may need to learn about it.. or reminded of it in your instance.. I think I may start on that project. Something to keep me focused

RRU96, that is a great idea -- it gives you something that moves in a helpful direction that doesn't involve those issues that are confusing to you at the moment -- a perfect way of building some momentum. Good for you!

This talk of patient assistance brings to mind a question... my ex-P-doc (I moved am moving again this week and don't have one currently) said that they are for brand name meds which don't have a generic. Is this true? (I'd be thrilled to find out it isn't as I'm on Lamictal and am quite anxious about being able to afford it (many life changes that put my abillity to afford it --and the generic is not much cheaper --in jeopardy.) Thinker22, you are so right in saying options help ease the mind, because feeling we don't is so very stressful!

Wishing you the very best in your research, RRU96. Hehe, those of us with bipolar sure can get into researching and in addition to all the info to be found, it has the added benefit of helping to keep our minds occupied. Keep us posted, ok?

[Anneinside]

Innerzone - Lamictal does have a generic equivalent - lamotrigine. That is what I take but I call it Lamictal because that's what everyone recognizes. It greatly dropped my drug copay cost from $45 to $10.

[thinker22]

I take lamotrigine too. I used to take Lamictal before the state started paying for it. See below. I don't notice the difference between the two.

As for lists to patient assist forms, there are several websites that perform this service.

http://www.needymeds.org/indices/pap.shtml
(Go to the upper left hand corner and choose generic or brand to look up your medicine.)

http://www.nami.org/Content/ContentG...e_Programs.htm

http://www.rxassist.org/patients/default.cfm

http://www.bridgestoaccess.com/ (This one is just for Glaxo-Smith-Kline and is how I got the brand name Lamictal before I was insured. I got it absolutely free and delivered directly to my mailbox. You just need to fill out the form, attach either pay stubs or your tax return, and have your p-doc sign it with the prescription, and provided you have no insurance, it usually comes within a couple of weeks). It's good for 6 months too, in terms of refills.

[RRU96]

Until you get into healthcare... it can be confusing on prescriptions sometimes. Here is the breakdown (btw, I was trained as a Medical Assistant).

For our story, we will use a Drug named.... RRU96. ABC Company has been researching this great new drug they think may be able to help with Bipolar. They do clinical trials, animal testing... you name it. BUT, the day that they file a claim for the patent on that drug.... the day they showed the efficacy, (proof that it works)... They then have 17 years to make as much money as possible. Alot of that time is tied up in studies and trials. But eventually they determine it is ready to go to market and start making money. BUT... the name RRU96 isnt real catchy... (in real life.. this name is the equivalent of fluoxetine) It is usually a chemical name that they used in the labs... not for TV. This name is the generic name. ABC Company needs a a catchy name for this new drug they have been working on... so they settle on... Ryan Ryan is real catchy... goes on the TV commercials well... and is something people will remember. RRU96 is STILL the generic name... But RYAN is now the BRAND name... the marketing name. So.... Generic exists the whole time... But until that 17 years is up... nobody else can MAKE it. Once the 17 years is up... you have generics that become available. That is.. Companies can now make this great medicine but just have to use the Generic name... RRU96.

I am SO sorry if that is confusing... but.. maybe it can clear out some of the confusion.

A little side note.. generic medications have to have something changed up. They cannot be identical to their trade name (or brand name) counterpart. Generic medications will change the color... taste... anything to make it just different enough to be legal. BUT PLEASE, keep in mind that if you are sensitive to medications.. they do have an allowance if U think 10%+-. Meaning that if you are on a medication that is 10mg, if you opt for the Generic medication...It might be 9mg... it may be 11mg. Usually this is not a HUGE problem but some people do have sensitivities.

If you are currently not on ANY form of insurance and you are not able to get on Patient Assistance.. and are trying to save Every Single Dollar... call around to different pharmacies around you. The way a pharmacy will draw you in... is by offering a really cheap... popular medication. If that one medication is cheap at pharmacy xyz, ONLY GET THAT MED. Call all of your local pharmacies... and check each of your medications. If you explain the situation, they shouldnt have a problem, as long as it isnt Rush Hour.

:: okay.... I'll stop :: ....... for now

[billieJ]

On the application or appeal, you need to add the reasons why each of your disabilities makes it hard/impossible to work. If bipolar alone keeps you from walking long distances, writing, typing, digging a hole, etc., point out those things on the extra space on the application. Try to cover as many reasons you can't work as you can. If delusions or mood impact your ability to interact with others,or to attend to a task, use that too.

[RRU96]

http://www.marthachurchill.com/ssmibasic.htm

This was a site I ran into the other day. It was an informative read... especially when you get to the THE FOUR AREAS OF FUNCTIONING

Maybe it can give you a little bit of a twist to try ?

[thinker22]

RRU, that was very informative. I think I'll print it off for my therapist and psychiatrist. They both did letters for the first go round, but maybe they don't know the criteria the gov uses.

Thank you much.

[jballiet35]

Originally Posted by thinker22

Hi guys,

I know I've not been on in a while. I was severely depressed since last October when the mania ended. A few weeks ago I started to feel better on a new medication combo/dosage. Then yesterday in the mail I get a denial letter for both social security disability insurance and supplemental income.

They said bizarre things like, "There are plenty of jobs you can work with your age and experience in the national economy." They totally didn't read my file. It doesn't matter what the job is, I can only focus to work 5-7 hours a week or two days of 4 hours a week. Even that is excruciating. I'm so exhausted after I work I can't do anything. It's like they're punishing me for working hard at being semi–functional.

Here's the issue. If I don't appeal and eventually get SSDI (at very least), I lose my state insurance plan that pays for my medications and hospital visits, etc. If I don't get my medications (which cost around $2,000 a month), I will be in the hospital on a regular basis and go bankrupt. So the state will end up paying anyway.

How do I get that through to them in a non-threatening way in my appeal letter?

Also, does anyone have experience with winning an appeal? How did you do it?

Thanks for your help. I'm so bewildered.

Hi iam a newbie here but i just wanted to post but I applied in aug of 2008 got denied in july2009, because of my age 39 and my education, they also said i could do various jobs, which they dont understand ive switched meds so many times after 15 yrs got the right dx... but half of the meds make me sick or sleep iam having a hard time just raising my daughter so anyway filed the appeal letter in sept 2010 and got a laywer and thankfully took my case but it could be 13 months from the time i filed the appeal before i get a hearing,so i did not win yet but the whole process is about two years approx so file the appeal and get a lawyer they will take 25% of your settlement so no cash up front but you only have 60 days to file so go to ssi office and tell them you want to file. or you have to go through the whole process agian. I hope this helps sorry for the ramble, good luck

[thinker22]

If they deny my first appeal, I am going to get a lawyer for the hearing.

Sorry it's taking you so long. I suppose it's not so bad the longer they draw it out in my case. It means I can keep my state benefits. But still, waiting on the SSI is not so great. I haven't paid rent since Nov 2008. My non-legal partner is having to pay for most everything due to my disability. That depresses me. I work as much as I can, but still can only cover the medical expenses that my insurance doesn't cover.

What are you going to do? It's their job to keep as many people as possible from getting disability. It doesn't matter if they really are disabled.

[IndigoRose]

Originally Posted by thinker22

Hi guys,

I know I've not been on in a while. I was severely depressed since last October when the mania ended. A few weeks ago I started to feel better on a new medication combo/dosage. Then yesterday in the mail I get a denial letter for both social security disability insurance and supplemental income.

They said bizarre things like, "There are plenty of jobs you can work with your age and experience in the national economy." They totally didn't read my file. It doesn't matter what the job is, I can only focus to work 5-7 hours a week or two days of 4 hours a week. Even that is excruciating. I'm so exhausted after I work I can't do anything. It's like they're punishing me for working hard at being semi–functional.

Here's the issue. If I don't appeal and eventually get SSDI (at very least), I lose my state insurance plan that pays for my medications and hospital visits, etc. If I don't get my medications (which cost around $2,000 a month), I will be in the hospital on a regular basis and go bankrupt. So the state will end up paying anyway.

How do I get that through to them in a non-threatening way in my appeal letter?

Also, does anyone have experience with winning an appeal? How did you do it?

Thanks for your help. I'm so bewildered.

Respond to their letter and ask for a hearing before a judge. Be very honest with the judge about what you're going through. SSDI & SSI almost always deny you the first time. Keep appealing. Most people don't fight, and they know that. Don't worry about how you come off to them. That money and the insurance for meds is due you, period.