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Topic: Short term disability insurance question (Read 292 times) |
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5-string
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Short term disability insurance question
« on: Sep 30th, 2003, 7:23pm » |
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Hi everybody,
I was wondering if anyone has had any success with this. I'm not and I'm broke because of it.
I initially put down"migraine" in the "what's wrong with you"box. Because some people have had more success with that discription.
I got a letter from the company which stated that they needed more info before they would continue to "consider" my case.
I called them and asked what they needed. They said they needed to know what had been done between July 20 and sept.03. So I faxed everything I had to them,including co-pay reciepts,pharmacy reciepts neurolist diagnoses which was cluster headache. Blahblah...
Then I recieved another letter saying they don't consider a "headache" reason enough to miss more then a day or 2 of work.
Because nothing showed up on the M.R.I. or CATscan there is nothing wrong with me.
I really don't want to hate them and wish terrible things upon the person with whom I'm dealing with but It's getting harder to rise above my frustration toward them. I did tell the person I've been dealing with that I really would like her to feel what we go through so she would understand and I said I wish it were as hard for them to deposit my money as it was to collect and I don't think I'm warming up to her very well.
I don't wish this pain on anyone honestly, not even her.
Does anyone have any advice or experience with this? I would forever be greatful. Thanks.
Take it easy,
...Mark..
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TxBasslady
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Re: Short term disability insurance question
« Reply #1 on: Sep 30th, 2003, 9:28pm » |
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Mark, this is just another example of stupidity and uneducation on the part of the insurance companies.
Did you try getting your dr to send a detailed letter explaining your condition? There is a huge difference in a "headache" and a CH, but evidently the insurance companies don't recognize this. This is another part of that perverbial bs that CH sufferers have to put up with.
Maybe your dr can beef up that letter and get their attention!
Good luck......and sending lotz of pf vibes your way.
Jean
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tsayswhy
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Re: Short term disability insurance question
« Reply #2 on: Sep 30th, 2003, 9:58pm » |
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Mark i am doing this very same thing now send in forms and they sent back another form with the exact same ?'s for my doctor to fill out again but i change migrains to cluster because of last year when i file under migrains they gave me a hassel. i got the money but not with out a fight. this year its been 8 weeks weeks and still no money. keep on fighting if you have a union where you work get them involve i did. dont give up if your doctor took you out of work then keep fighting i am calling my sister tomorrow because at her work she is the one dealing with this kind of stuff and i'll ask her if they can hold it up like this i will ask if there is any thing we can do and i will post back to you.Tari
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Donna_D.
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Re: Short term disability insurance question
« Reply #3 on: Oct 1st, 2003, 12:44am » |
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I am new to CH but not to insurance companies...I worked for one for 10 years.
Words of advice:
Don't give up after the first try. This is a common tactic used by ins. co.'s. They count on people accepting no as the final answer.
Have your physician write a detailed letter explaining the "debilitating nature" of your condition. MD support/advice is always top consideration when making a determination of pay vs. no pay.
Call every day if you have to. Squeaky wheels get greased!! Remember, everyone has a supervisor. If you don't get the answer you need from the first person you talk to (who is usually a peon with no medical training) ask to talk to their boss. Ask to talk to someone in the corporate office if you have to.
Print out some pages from this web site. Like I said, I am new to CH and have found the information here to be above and beyond anything else out there on the subject of CH.
DON'T GIVE UP!!
If you need help, email me with specific questions and I will do what I can.
Good Luck!!
Donna D.
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OneEyeBlind
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Re: Short term disability insurance question
« Reply #4 on: Oct 1st, 2003, 5:30am » |
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I filed under the Family Medical Leave Act. This gives you 12 weeks off (which can be used sporadically) and protects your job. I didn't have to deal with the insurance company cause work still paid me since under our short term disability policy. The only thing I had to do was take the pre-printed form to my doc and have her fill out her portion. Worked for me. Now long term disability is another thing. But the FMLA works for short term disability really well and protects your job !
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KingOfPain
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Re: Short term disability insurance question
« Reply #5 on: Oct 1st, 2003, 7:49am » |
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5-string quote:
" Then I recieved another letter saying they don't consider a "headache" reason enough to miss more then a day or 2 of work.
Because nothing showed up on the M.R.I. or CATscan there is nothing wrong with me. "
Have them explain that to the beast. 
KingOfPain
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Dave_Emond
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Re: Short term disability insurance question
« Reply #6 on: Oct 1st, 2003, 8:35am » |
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I've been working on this issue for an extremely long time now. My goal has been to present an information package on disability issues for the OUCH website. It will not be an endorsement of OUCH to encourage disability, rather a medium of information requested by members.
This task has been far more difficult to achieve than I could have guessed. I do have much information on how to go about dealing with the first intial steps should one be in need of SSA assistance.
My first priority in this project is to protect the information against outsiders looking for a way to "scam" the system. However, anyone trying to do that, isn't going to find Cluster Headaches as a route to go.
There will be many forms, and they will be repeated. The most important thing is honesty, which leads to consistency. Inconsistency on forms will raise flags, and should.
I was forced to sign up for SSA by my workplace benefits agency. Being pretty stubborn and proud, I did not want to do this. Doctor and Neurologist insisted I should not work as I was endangering fellow workers and traffic.
"Headache" is the killer word when dealing with anyone who does not understand CH. When I went to SSA (which I highly suggest as much face to face dealing with your agent) I brought the paperwork from the doctors as well as info I printed from this site and OUCH about the true aspects of CH. I also wrote a statement describing how CH effected my daily routine.
In your case, you're going to need your doctor (and hopefully you have a neurologist) to either fill out the paperwork again, or at least have them write a statement if they believe you should not be working. It is also important to let the SSA know that you are willing to try to work in any capacity you can. You may have to change jobs, if you are not willing to do everything possible to be self sufficient, then you'd be giving into the Beast, and he can beat you that way.
If you get assistance, don't think you'll be able to live off that, it is not much. You will have to cut back almost everything not neccesary in your budget.
Stay in constant contact with your assigned agent. It helps once they start to grasp the concept of CH. I was episodic when I first went through this process. My cycle ended during the "waiting period" and I went back to SSA and asked to be removed. They refused, stating that, from the doctors reports and follow up they had done, it would cost them more to take me off and possibly put me back on. It can be a blow to one's self respect to need assistance, but the SSA turned out to be right on this call. I went chronic after my next cycle hit. Until recent events in my life, I have been working as much as possible to try to become self sufficient, and I report every penny to SSA. Getting off SSA is probably more difficult than getting on. I've tried several times to be removed, but they have standards of proof guidelines you must provide them to show you are capable. After time, they offer Medicare. Again, out of pride, I did not fill out or return the forms thinking it would not go into effect. Again they were right, they proccessed the Medicare anyway. With recent new problems, which I couldn't pay for, Medicare kicked in along the way, if it hadn't, I wouldn't be here today.
Feel free to E-mail me with questions on this, I'm pretty much in hospitals everyday now, but should be able to find time to go into more details.
The key things:
Honesty
Consistency
CH information
Doctor forms and statements (Neurologists as well)
Talk face to face with agent, stay in contact.
Be willing to work in any capacity you can.
Fight to become self sufficient.
Some basic stuff here, hope it helps somewhat,
Dave
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2late
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Re: Short term disability insurance question
« Reply #7 on: Oct 1st, 2003, 9:37am » |
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i'm presently on std for clusters, your doctor must word it very clearly that you cannot work due to this & even then they'll fight you. I didn't get satisfaction until my neuro did this for me & dealt with my caseworkers supervisor, then my case was turned over for peer review & the peer asked my neuro this unbelieveable question, BESIDES FOR THE PAIN WHY CAN'T HE WORK........my doc still get's a kick outta that question. all i can tell you is keep on these peoples ass & have your neuro work for you. best of luck to you! .................Jack
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5-string
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Re: Short term disability insurance question
« Reply #8 on: Oct 1st, 2003, 10:43pm » |
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Thank you so much for the advice. I will continue to persue this until I get what I need. If nothing more than for the sheer principle of it. for some reason credit card debt does'nt bother me as much as buckling under the "system" does.
Allowing an insurance co. to keep my paycheck when it belongs to me (because they don't care to understand what a cluster headache is and recognize this as a "legitimate ailment" does'nt sit well. the system needs to know that these are in fact for real.
With the advice and encouragement I have recieved here I will do what I need to. The support from all of you is unmeasurable.
Thank you again,
...Mark..
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