Tag Archives: social security applications

Discrimination By Insurance Companies Against The Chronically Ill

 

Despite the Affordable Care Act (ACA), commonly called “Obamacare,” and its requirement that medical insurance companies accept those with pre-existing conditions, insurance companies have found ways to deny services while keeping their eyes on the bottom line at the expense of those patients who are the most vulnerable.

An article by Angela Ostrom, published in Newsweek, points to the denial of quality coverage to patients with epilepsy, cancer and a host of other chronic conditions.  New and creative ways are found in which medical insurance companies could “skirt around” the lawful charge and focus of the ACA.

“One common strategy is to design plans so that medications for conditions like epilepsy, cancer [ME, fibromyalgia, lyme disease and others] and HIV/AIDS are all but unaffordable.”

“Federal rule makers are set to change that. They’re attempting to prevent insurance companies from denying quality coverage to patients with epilepsy, cancer and a host of other chronic conditions.  If they succeed, they’ll have, at long last, achieved one of the ACA’s most important goals:  ending discrimination against sicker patients.”

It is widely known that Big Pharma is getting rich upon the backs of unfortunate sufferers of chronic and/or serious and life-threatening illnesses.  These patients have huge medical and prescription costs – a greater percentage than those of us who are blessed with good health.  The more ill the patient is, the higher their cost of medical care, of course; however, the more ill the patient, the less income.  A paradoxical situation, but that’s the truth of it.

“The ACA bans insurers from outright refusing to cover people with pre-existing conditions. Unfortunately, that provision didn’t actually stop insurance companies from turning away chronically ill patients—it just forced them to find new and creative ways to do so.

Cutting back on prescription medication.  It's too expensive.

Cutting back on prescription medication. It’s too expensive.

“Insurers place many or all medications for a particular condition on the highest “tier” of their drug formularies—the lists of medicines patients are allowed to take, or off the formulary altogether. For medications in the highest tier, individuals are often required to cover 40 percent—or more—of the total cost.”

“Sadly, this technique for raising the cost of essential and often lifesaving therapies is now standard.”

There are other tactics that medical insurance companies use in order to make it more difficult for very ill patients to get the medication and care they need.  Too many patients don’t buy the medication they need.  It’s too costly.  Many patients cut back on their dosage of medication, trying to make it last longer, but while doing this, they render the medication useless as it then has no beneficial effect.

On another note:

Assistance from governments – state and/or federal – is like trying to trudge through a mud slide several feet deep, while going against the slide’s direction of movement.  Not a good picture.

Social Security Disability applications go through an automatic first denial.  One applicant’s application was denied along with the explanation for denial that had totally nothing to do with the applicant’s reason for applying for financial relief.  It was evident that the federal employee didn’t take the time to actually read the application and accompanying documentation.  Or, he/she was under orders to automatically deny.  This tactic sounds more reasonable, since Social Security Administration keeps complaining about its bottom line.

As with too many federal agencies, the weakest keep getting pushed “under the rug.”

[Pill box image from bingdotcom]

[ Header image from http://www.freewebheaders.com ]

 

 

Social Security Disability is Nearing Insolvency

Yes, it’s true.

disability

Here are the main reasons for this disastrous event in the near future, if Congress does nothing to fix it:

  • There have been an increasing number of people receiving SSDI while there is less revenue in payroll taxes coming in.
  • The aging Baby Boomers reaching the prime disability age (70% of disabled workers are age 50+) , and the increase of the number of women in the workforce (and therefore being covered by this program), have caused 1/3 of the increase.
  • People living longer (therefore staying on the rolls instead of dying), and the increase in the age of retirement (shifting more people onto SSDI than retirement) have also contributed.
  • An additional factor is the new disease guidelines implemented in 1984, allowing disability payments for mental illness and musculoskeletal illness (back pain, depression and fibromyalgia are three often mentioned diseases in this category).  While heart attack and stroke have remained steady, the incidence in these new diseases has increased, accounting for a whopping 50% of the increase.
  • Also, there are myalgic encephalomyelitis (ME) patients who also suffer with fibromyalgia.
  • A loss of revenue from payroll taxes. On the demographic side, the Baby Boomers had less children, so there are less workers paying into the system. Where there used to be 17 workers contributing for every recipient, there are now only 3.
  • The increasing income inequality has also contributed to the problem. There is a cap for workers at wages of $118,000 a year. Those making more do not pay more into the system. As more people are making over this amount, revenue has decreased.
  • There is the issue of fraud in the system.  While nobody wants to deny deserving applicants benefits, fraud must be held in check so that funds are available for the truly disabled.

The subject of Social Security Disability application denial or acceptance is a hot one.  The fear of fraudulent claims has pushed our government to deny too great a percentage of applications that are truly deserving.  Nearly 65% of disability claims are denied by judges.

denied

In order to understand how the Social Security Disability funds are allocated, it is important to note that the program is made up of two divisions:  a smaller one for disability; and a larger one for old age retirement.  Payroll taxes collected from those currently working are divided into two streams:  one for SSDI; and one for the retirement fund (also called the Old-Age and Survivors Insurance or OASI).

A little history:  Since the 1970s, funds have been reallocated 11 times from SSDI to OASI, and vice versa, when either fund was in need. This worked fine when overall, there was enough money to fully fund both. However, due to demographic and other factors, the overall program is projected to become insolvent in 2033. This is 18 years from now – not as far off as it might sound, given the time it takes our government to roll out reforms.

Many Senators stated that while nobody wants to cut funding for the disabled, they will not let a reallocation go through unless there are also reforms to the SSDI program (and possibly OASI) to either cut costs or bring in more revenue or both.

My advice:  Contact your Representatives and Senators to fix this before we have a very serious problem on our hands.  Our disabled citizens need the continuing support they deserve, and they are dependent upon our healthy, working Americans to help.  Those, who are healthy and can work, need to appreciate something they might not think about:  They could find themselves in the same situation one day, and then need the help of Social Security Disability.

[Images from bingdotcom]

[ Header image from http://www.freewebheaders.com ]