Recent hand-wringing over bankruptcy of Medicare/Medicaid confirms that 80% of applications for disability assistance are rejected at first application. This is a nationwide average, and it's significantly worse in some states.

1. First application for a Medicare/Medicaid disability benefit requires full reporting from ALL PHYSICIANS who have seen the applicant in the past year.

2. First application requires a complete examination of the applicant by an "independent medical practitioner" designated by the agency.

3. First application requires a psychological examination by a psychologist/psychiatrist designated by the agency.

4. First examination requires completion of an application form of about 30 pages by the applicant.

5. First application requires submission of a 12 page "questionnaire" by each of at least "3 different persons who know the applicant."

6. Any additional examination requirements "deemed necessary" by the agency MUST BE COMPLIED WITH. A "second opinion" by another medical "specialist" is usually demanded.

7. An "interview" with an agency employee is required. This interview theoretically can be done by telephone, but the telephone interview invariably results in a demand the the applicant "come to the office" to answer "additional questions."

8. ALL REPORTS are "privileged communications" between examiners and the agency, and the applicant IS NOT ALLOWED TO KNOW WHAT WAS REPORTED.

8. No rationale for the inevitable rejection is provided.

Numbers are less verifiable, but approximately 60% of those rejected apparently will file an appeal. Of those who appeal and persist, the national average is that 98% will eventually be awarded a disability benefit.

10. Those who appeal are required to re-submit the same 30 page application. (The prior submittal will be rejected)

11. New reports (approx 12 pages each) from "3 persons who know you" must be provided.

12. NEW REPORTS from all of the same of their own medical providers as in the first round, plus reports from all additional practitioners who have seen them since the original application must be submitted. (Don't forget the ones they sent you to.)

13. A new medical exam is required by one or more designated practitioners. In our personal experience the local practice is to designate "less accessible" persons for the appeal exams.

14. A new psychological/psychiatric exam by an agency designate is required. See above re "accessibility."

15. In our area, the same 80% arbitrary denial is applied to all "first appeals." Nearly all will re-file a second appeal.

16. On Second appeal, a complete new set of application forms must be submitted.

17. Three of your acquaintance must again complete the 12 page (approximately) report on their observations of you.

18. A new report is demanded from each medical provider who has seen the applicant. In this case the time is "back to one year prior to first application. (Don't forget both sets of those they sent you to in prior rounds.)

19. A new examination by a different designated "medical person" is required.

20. A new psychological/psychiatric exam by a designated person is required.

For all of the above, decreasingly accessible "designates" were chosen for us:

20.a. In our case, applying for disability in which "limited mobility" was significant, the "handicap parking" was within "legal distance" of the building, but the only entrance was 216 feet further (outside). Inside, a 184 ft long hallway led to a "sunken" lobby. The only directory to indicate examiner's office location was sunken in a display that could not be seen by a person seated in a wheelchair or mobility device. To reach the elevator required ascending 12 stair steps. (Say goodbye to the wheelchair?). The elevator exit was 184 feet from the office. When the need arose, we found that the nearest restroom was NOT ACCESSIBLE. Had she sat down on the pot there was insufficient aid available to get her off of it. The "handicap" restroom was 387 feet down the hall past the elevators.

It took the "applicant' about 75 minutes to get from the vehicle to the office on the first trip.

21. After the above, you wait for assignment of an "administrative judge" and for a "hearing date."

22. In our case, the wait was just over 2 years for the "assignment," and a further 7 months for the "hearing."

23. Since the disability had been fully confirmed at first application, no mention of the applicant was made at the "hearing." The "judge" asked if the applicant smoked and was told "No." He then asked if the applicant drank coffee. Applicant admitted to "about a cup every couple of weeks." The judge then delivered a 40 minute "lecture" on his theory that no one would be disabled if everyone stopped drinking coffee (he read up on it on the Internet), haggled briefly with the attorney about the "agreement on retroactive benefits" (required back to date of disability in the regulations, but settled for "attorney's fee" as of the hearing.)

Total time from first application SIX YEARS AND FOUR MONTHS.

Total benefit received, approx $130/month, and one year earlier eligibility for Medicare in place of existing Blue Cross.

(The "disability benefit" for those over 56 only allows payment of the benefit they would receive at "full retirement," based on their individual earnings and payment of SS taxes, rather than the reduced benefit for starting regular Social Security at the age when disabled, and Medicare 2 years after disability is awarded instead of at age 65. Unlike insurance benefits, Social Security "income" IS TAXABLE.)

And the Governor of Florida thinks one piss in a cup will "clarify everything?"

IF he agrees with my assessment that NO PRACTITIONER that the agency demanded must evaluate our applicant was qualified to treat me for a blister on my thumb, he may have something, I suppose.

John