It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Health Insurance Issues Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 02-06-2012, 08:40 AM   #16
Member
(female)
 
cvidmama's Avatar
 
Join Date: Nov 2011
Location: Bakersfield, CA
Posts: 54
cvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB User
Re: Getting approval from doctor for disability

Quote:
Originally Posted by GregBear4you View Post
Hello BlueSkies,

You asked me: "How long have you been on STD? Is LTD provided by the same insurance company who approved the STD? My STD was administered in-house by the company I worked for. You are on STD so your doctor must have filled out the necessary paperwork for that. Why not ask him/her if your STD runs out and you are still sick, would they support your claim for LTD?"

STD - a little over a month now have been on STD - my company I work for pays for it. Will last no more than 12 weeks, unless apply for an extension.
LTD - is through an insurance company, by premiums I pay into at work.
Yes, my doctor signed the STD forms with no reservations. I was really shocked, but, so glad he did. My insurance is not going to give me the gammagard drug; the immunologist there said "you really don't have an immune deficiency disorder unless you IGg level is below 400. What a line of bull! I am very angry!

I am deficient in IG 650, sublcasses 1 and 3, which have to do with recurring infections and lung infections.

We now are applying for the CVIG drug, but there is a 6 month pre-existing condition clause., so therefore, I will have to go on LTD until I can get this drug, then be re-evaluated. I am certain the Kaiser doctors will not support me for LTD, but they might, so I have to have this talk again with my Immunologist. I am praying he does support this. Again, I feel nervous about asking, because if I get turned down, there is really no one else who could help me.

Thanks for your help, BlueSkies!

GregBear4you
Hi there,

I wanted to explain that IVIG (not CVIG) is not really a drug....its human blood product that comes from a very large pool of donors. I explain it to my friends this way: "people donate blood and the blood companies are able to take out their immune system (IgG) and put it in a bottle and give it to me". Also, try not to be cross with your doctor, there is a standard out there for most insurances/diagnosis that you have to be 2 standard deviations lower than normal (guessing sorry, if you like I can find you the EXACT verbiage). You could have an immune deficiency at 500 total IgG - but the correct tests need to be done or no one will pay for IVIG. Did they do the vaccine challenges on you?

 
The Following 2 Users Say Thank You to cvidmama For This Useful Post:
ferd144 (02-06-2012), GregBear4you (02-09-2012)
Sponsors Lightbulb
   
Old 02-07-2012, 12:47 AM   #17
Senior Veteran
(female)
 
twohands's Avatar
 
Join Date: Dec 2010
Location: USA
Posts: 584
twohands HB Usertwohands HB Usertwohands HB Usertwohands HB Usertwohands HB Usertwohands HB Usertwohands HB Usertwohands HB Usertwohands HB Usertwohands HB Usertwohands HB User
Re: Getting approval from doctor for disability

GregBear,

Sorry to hear of your difficulties with navigating the medical and disability insurance issues.

Regarding STD/LTD, when you talk to your doctor to request their approval for you to stay on disability, it's a really good idea to give specific examples of why you don't feel you'd be able to hold down your job without getting fired, such as I'm too tired to do dishes or cook anything more than a simple meal, I get bad headaches on a daily basis, I have breathing difficulties about 2 times per day, etc.

In order for your doctor to keep you on disability, however, there needs to be medical evidence of your problem and the severity of it. Examples of medical evidence can include blood tests, xrays, MRI's, other types of imaging, or other medical tests that aren't subjective. Regarding the severity, I agree with the other poster that they will look for evidence of your inability to work, such as frequent doctor appointments/hospitalizations/tests, etc.

The DI carriers really are a pain to deal with - they will call you at least once a month and ask when you plan to return to work, and they will regularly send you paperwork that you and your doctor have to fill out to show you are still eligible, and they will get your medical records regularly. If they see an opportunity to get you off their policy, they will try their hardest to. Be prepared for this and fight for the benefits you need and deserve. Get copies from your employer of the STD and LTD policies that were in effect the day you last worked, as you will likely need to refer to them to understand your benefits and rights.

It would also be a good idea to file for SSDI sooner vs. later. Approx. 20-25% of people get approved at their first application, so you might get lucky or you might have to wait for a hearing in front of the judge where most people get approved. The process takes a long time and it's best to start the process as soon as possible in case you aren't able to return to work.

I really hope you can get your condition under control and get back to work, but it's a really good idea to prepare for the worst. My LTD DI carrier forced me to apply for SSDI and I thought it was ridiculous at the time as I really thought I'd be going back to work as soon as my back healed. Six spine surgeries later I now know I won't be able to return to work and am really glad I have SSDI.

Regarding getting Medicare, it's 2 years and 5 full months (they start counting on the 1st day of the month after you last worked) from the date you last worked. That's another reason to get going on your SSDI application, so this date won't be delayed should you need Medicare.

Best wishes!

 
Old 02-07-2012, 02:47 AM   #18
Inactive
(male)
 
Join Date: Mar 2011
Location: USA
Posts: 2,602
BlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB User
Re: Getting approval from doctor for disability

Quote:
Originally Posted by twohands View Post
GregBear,

Sorry to hear of your difficulties with navigating the medical and disability insurance issues.

Regarding STD/LTD, when you talk to your doctor to request their approval for you to stay on disability, it's a really good idea to give specific examples of why you don't feel you'd be able to hold down your job without getting fired, such as I'm too tired to do dishes or cook anything more than a simple meal, I get bad headaches on a daily basis, I have breathing difficulties about 2 times per day, etc.

In order for your doctor to keep you on disability, however, there needs to be medical evidence of your problem and the severity of it. Examples of medical evidence can include blood tests, xrays, MRI's, other types of imaging, or other medical tests that aren't subjective. Regarding the severity, I agree with the other poster that they will look for evidence of your inability to work, such as frequent doctor appointments/hospitalizations/tests, etc.

The DI carriers really are a pain to deal with - they will call you at least once a month and ask when you plan to return to work, and they will regularly send you paperwork that you and your doctor have to fill out to show you are still eligible, and they will get your medical records regularly. If they see an opportunity to get you off their policy, they will try their hardest to. Be prepared for this and fight for the benefits you need and deserve. Get copies from your employer of the STD and LTD policies that were in effect the day you last worked, as you will likely need to refer to them to understand your benefits and rights.

It would also be a good idea to file for SSDI sooner vs. later. Approx. 20-25% of people get approved at their first application, so you might get lucky or you might have to wait for a hearing in front of the judge where most people get approved. The process takes a long time and it's best to start the process as soon as possible in case you aren't able to return to work.

I really hope you can get your condition under control and get back to work, but it's a really good idea to prepare for the worst. My LTD DI carrier forced me to apply for SSDI and I thought it was ridiculous at the time as I really thought I'd be going back to work as soon as my back healed. Six spine surgeries later I now know I won't be able to return to work and am really glad I have SSDI.

Regarding getting Medicare, it's 2 years and 5 full months (they start counting on the 1st day of the month after you last worked) from the date you last worked. That's another reason to get going on your SSDI application, so this date won't be delayed should you need Medicare.

Best wishes!
Hi two hands....longtime, where ya been? I agree with what you said about LTD. You must always remain vigilant as long as you are on LTD because they will drop you if they can. Generally, most for profit companies enjoy receiving monies in (premiums) but they wanna keep it and not have to pay it back out (claims). LOL Nice to see you again!

 
The Following User Says Thank You to BlueSkies14 For This Useful Post:
GregBear4you (02-24-2012)
Old 02-09-2012, 12:58 AM   #19
Junior Member
(male)
 
Join Date: Oct 2011
Location: Centreville, VA
Posts: 20
GregBear4you HB User
Re: Getting approval from doctor for disability

Hi cvidmama,

My lab work and most of my vaccines have come back ok, but we are still waiting on results for some.

I am deficient in Subclasses IG 1 and 3; having to do with recurring infections and lung infections. I have tried everything over the years, but nothing stops these infections from happening. I really need the IVIG drug to ward off infections.

My immunologist I initially saw, put in a prescription to the infusion co. for the drug. They are working with United Health Care, so I am hoping for the best.

I am praying to go on LTD if I don't get the drug, as I will not improve, but get worse.

Thanks for your help.

- G

 
Old 02-09-2012, 06:33 AM   #20
Member
(female)
 
cvidmama's Avatar
 
Join Date: Nov 2011
Location: Bakersfield, CA
Posts: 54
cvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB User
Re: Getting approval from doctor for disability

There is a wealth of information on the internet:

It is important to consider that the concentrations of IgG subclasses vary up or down over time and the normal ranges used in different laboratories also vary. Normal values are usually“defined”as those values between two standard deviations below and above the average for that person’s age. Unfortunately, that may give the impression to some physicians and patients that individuals below the second standard deviation are abnormal when 2.5% of normal individuals fall below this level. The finding of a mild IgG subclass deficiency should prompt re-evaluation over a period of months before calling that person abnormal. Subclass deficiencies need to be interpreted by taking into account the clinical status of the patient as well as the ability to produce specific antibodies in response to childhood vaccines.

Typically propholactyic antibiotics are used then if necessary, IVIG. Trying to provide information on diagnostics and treatments so you are aware of the steps typically required to "make insurance companies happy". Good luck.

 
Old 02-20-2012, 07:34 PM   #21
Junior Member
(male)
 
Join Date: Oct 2011
Location: Centreville, VA
Posts: 20
GregBear4you HB User
Re: Getting approval from doctor for disability

Yes. They did.
They said, as far as I know, the vaccines came back with good responses. My IGg levels are still low; particularly subclasses 1 and 3.

The chances are good I will be approved for SubQ for the drug hyzentra - my Immunologist wrote the order and feels I really need it. I was approved by UHC for "in network" benefits. My advocate with Bio Rx infusion says the chances are good they will approve it soon, but want to see for sure.

I am wondering, do most ppl with CVID, like I am on STD right now, even when they have the IVIG tx, do they go on LTD and SSDI? and/or, is this the norm for the doctor to put them on LTD and SSDI?
The reason I ask is that I am concerned after the treatment about relapse, other issues I have like bronchitus/asthma (my lungs are sore when I breathe cold air and I get really sick) are not getting any better. Do these other issues, such as asthma clear up too, with the SubQ tx?
If I get completely healthy, I would like to go back to work, but if not, would not be a good idea.

I don't know what to do about asking my doctor about LTD. Should I apply just in case? my job wants me to return on Mar. 26th; after this date they are going to let me go. What should I do? I don't want to wait too long to apply for LTD, and, my job manager wants to know what I plan on doing come early March.

Please, any guidance is appreciate by anyone. I appreicate everyone's help so far.

Thanks for the help and direction...

 
Old 02-20-2012, 08:05 PM   #22
Member
(female)
 
cvidmama's Avatar
 
Join Date: Nov 2011
Location: Bakersfield, CA
Posts: 54
cvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB User
Re: Getting approval from doctor for disability

Most people with CVID go on to live a normal life, have kids, work full time, etc. BUT that being said the treatments take 6 months to a year to work. Meaning - this is NOT a cure. This will significantly reduce the number and severity of your infections. Unless you are hospitalized multiple times per year AND need multiple rounds of antibiotics, its not likely you will get approved. ALSO, you haven't' even started treatment, which more than likely will work. I can't see anyone approving ssdi/ltd when you haven't' started the treatment that will give you a close to normal life. This is all my personal opinion and what i've read about the qualifications for ssdi. I got a deadly lung disease from cvid and I can't even get ssdi I work full time, single mom, own my own home, voluteenr...I live a normal life. Asthma will not go away with the Igg replacement (IF it really is asthma). Start the treatments asap. Its very unusual for you to go straight to subq, the standard is usually one ivig THEN to the subq. Hope I answered some of your questions.

 
The following 2 users give hugs of support to: cvidmama
BelleoftheSouth (02-21-2012), GregBear4you (02-20-2012)
The Following User Says Thank You to cvidmama For This Useful Post:
GregBear4you (02-20-2012)
Old 02-21-2012, 02:02 PM   #23
Senior Veteran
(female)
 
Join Date: Oct 2008
Location: Connecticut
Posts: 556
BelleoftheSouth HB UserBelleoftheSouth HB UserBelleoftheSouth HB UserBelleoftheSouth HB UserBelleoftheSouth HB UserBelleoftheSouth HB UserBelleoftheSouth HB User
Re: Getting approval from doctor for disability

If SSD thinks for a second that you can work with medicines to help you they won't approve. You can get approval from your doctor but their doctor will be assessing you which makes me steaming because their doctor very seldom agrees with your doctor.

~Belle~

 
The following user gives a hug of support to BelleoftheSouth:
GregBear4you (02-21-2012)
The Following User Says Thank You to BelleoftheSouth For This Useful Post:
GregBear4you (02-21-2012)
Old 02-21-2012, 04:47 PM   #24
Facilitator
(female)
 
SpineAZ's Avatar
 
Join Date: Oct 2005
Location: Wisconsin
Posts: 5,106
SpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB UserSpineAZ HB User
Re: Getting approval from doctor for disability

STD done in-house by the employer is usually way more generous in not requiring a lot of medical evidence, often only a doctors signature and diagnosis you have.

LTD done by an insurance company will be far more focused on medical evidence, residual functionality, etc. It's no longer just a doctor's signature, but the doctor backing up the diagnoses and limitations and symptoms with medical records. Just be prepared. If your LTD starts after 6 mo on STD and LTD feels you will be unable to return to work, they will likely encourage you to apply for SSDI. Often LTD insurance companies refer claimants to preferred SSDI attorney or advocacy firms.

My LTD did refer me to their preferred attorney group and they handled 90% of the SSDI from initial application all the way through to approval. In the beginning I had to help them in providing all my doctors, medical history, work history, etc.

Remember to claim ALL the diagnoses you may have. I have a 50% hearing loss bilaterally that hasn't really interfered in my job too much but the judge gave it a high impact in terms of solidifying her decision to approve my SSDI becuase it limits the job types I can do (can't work in quiet environments, call centers, or noisy environments, etc)
__________________
Rt thumb fusion '13. R&L thumb arthroplasty '12 ; RT TKR & Bilat CTS' 11. Fusions: L5-S1('87), L4-S1('93), C5-C7('06), L3-S1('10), C4-C5('13). C5-C7 foraminotomy '08

Last edited by SpineAZ; 02-21-2012 at 04:51 PM.

 
The following user gives a hug of support to SpineAZ:
GregBear4you (02-21-2012)
The Following User Says Thank You to SpineAZ For This Useful Post:
GregBear4you (02-21-2012)
Old 02-22-2012, 11:01 AM   #25
Inactive
(male)
 
Join Date: Mar 2011
Location: USA
Posts: 2,602
BlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB UserBlueSkies14 HB User
Re: Getting approval from doctor for disability

Quote:
Originally Posted by SpineAZ View Post
STD done in-house by the employer is usually way more generous in not requiring a lot of medical evidence, often only a doctors signature and diagnosis you have.
Yep, Spine is right. I always had in-house STD and I used it about a dozen times over my 20 year career span and my company never gave me a huge hassle....just a signature from a doc once / month along with the prognosis/diagnosis.

 
The Following User Says Thank You to BlueSkies14 For This Useful Post:
GregBear4you (02-22-2012)
Old 03-06-2012, 08:38 PM   #26
Junior Member
(male)
 
Join Date: Oct 2011
Location: Centreville, VA
Posts: 20
GregBear4you HB User
Re: Getting approval from doctor for disability

Great news! UHC approved my IVIG therapy and I will be getting my first infusion this coming Friday!

The drug is called "gammagard" and I will received treatment once a month. Just got my shipment today at home.
Has anyone had experience with getting IVIG/gammagard? what do I need to expect?
I read the list of possible side affects.

From what I understand, the 4th week afterwards you may start to feel sick again because it raises the IGG up and then drops?

Or will I feel better after my treatment; from what one other poster stated earlier, it will take weeks to start to feel normal however?

I am also concerned about my asthma. I breathed in cold air from outside one night, just briefly; the next morning I had severe chills/fever and muscle aches. Was sick all day. I am not sure if these issues will resolve or not, after I get the IVIG. Most likely no. Also, I had an asthma attach the other day and could hardly breathe and got dizzy and light headed. Almost had to call an ambulance.

I spoke to HR and they are going to extend my leave another 2 weeks so I can get a good feel for the drug and how I will react during, and later/afterwards.
I spoke to my doctor and he signed my LTD form and I submitted to HR, just in case I have the worse case senario. Best case senerio is I will be able to return to work before my FML is up. HR told me, if I go back to work and then get sick again, I could go out on STD again; however I would lose my job because of using up FML for the year.

Thanks.
-G

 
Old 03-06-2012, 08:40 PM   #27
Junior Member
(male)
 
Join Date: Oct 2011
Location: Centreville, VA
Posts: 20
GregBear4you HB User
Smile Re: Getting approval from doctor for disability

Great news! UHC approved my IVIG therapy and I will be getting my first infusion this coming Friday!

The drug is called "gammagard" and I will received treatment once a month. Just got my shipment today at home.
Has anyone had experience with getting IVIG/gammagard? what do I need to expect?
I read the list of possible side affects.

From what I understand, the 4th week afterwards you may start to feel sick again because it raises the IGG up and then drops?

Or will I feel better after my treatment; from what one other poster stated earlier, it will take weeks to start to feel normal however?

I am also concerned about my asthma. I breathed in cold air from outside one night, just briefly; the next morning I had severe chills/fever and muscle aches. Was sick all day. I am not sure if these issues will resolve or not, after I get the IVIG. Most likely no. Also, I had an asthma attach the other day and could hardly breathe and got dizzy and light headed. Almost had to call an ambulance.

I spoke to HR and they are going to extend my leave another 2 weeks so I can get a good feel for the drug and how I will react during, and later/afterwards.
I spoke to my doctor and he signed my LTD form and I submitted to HR, just in case I have the worse case senario. Best case senerio is I will be able to return to work before my FML is up. HR told me, if I go back to work and then get sick again, I could go out on STD again; however I would lose my job because of using up FML for the year.

Thanks.
-G

 
Old 03-07-2012, 05:58 AM   #28
Member
(female)
 
cvidmama's Avatar
 
Join Date: Nov 2011
Location: Bakersfield, CA
Posts: 54
cvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB Usercvidmama HB User
Re: Getting approval from doctor for disability

All brands of IgG replacement affect each individual differently. I have used 4 different IVIG products before switching to subcutaneous, which I have used 2 brands, one being Gammagard. I had HORRID side effects from IVIG. My best advice is to drink plenty of fluids before and have Gatorade on hand in case you get a headache. No pain medications in the world will get rid of that migraine once you get it. I would also ask ahead of time what speed they are planning on using...the slower the BETTER. The speed accounts for 90% of side effects from IVIG (I did a survey that about 60 people or so answered and these are the TOP suggestions for IVIG). Plan for it to take most of the day, bring a blanket, snacks, and something to keep you occupied. If you feel anything unusual during, ask to slow it down or STOP for 15 minutes. I personally, would be bed ridden the day of and all day after, so I had mine on my Friday off work. By 6pm Sunday, I would be well enough to cook dinner. Remember, IVIG does NOT work over night, it takes 6 months to a year to see a noticeable improvement in the severity and frequency of infections.

 
The Following User Says Thank You to cvidmama For This Useful Post:
GregBear4you (03-07-2012)
Old 03-07-2012, 06:15 AM   #29
Senior Veteran
(female)
 
Join Date: Sep 2010
Location: texas
Posts: 1,349
jgrangran HB Userjgrangran HB Userjgrangran HB Userjgrangran HB Userjgrangran HB Userjgrangran HB Userjgrangran HB Userjgrangran HB Userjgrangran HB Userjgrangran HB Userjgrangran HB User
Re: Getting approval from doctor for disability

Gregbear4you, Gee I'm truely sorry you have to go thru this how in the world can some work like that it takes a long time to get back to normal and then will that be it until When it starts over again. I would file for disability and see what happens. Good Luck in your treament.

 
The Following User Says Thank You to jgrangran For This Useful Post:
GregBear4you (03-07-2012)
Old 03-07-2012, 03:24 PM   #30
Junior Member
(male)
 
Join Date: Oct 2011
Location: Centreville, VA
Posts: 20
GregBear4you HB User
Re: Getting approval from doctor for disability

Thank you, CVIDMama and thank you, jgrangran.

I will take your advise to heart about the treatment taking 6 months to a year before I feel normal, CVIDMama. Thanks. In the meantime I am preparing for the worst case senario.

I filed for LTD through my place of employment. It is a disability insurance company.
They called today and left a voice mail stating they wanted me to call them back and do a "phone interview" with them. Do I have to do this? anyone know?

I called PP Legal and asked to speak to a disability lawyer before even talking to them.
This is getting scary.
Concerned about my first infusion coming up this Friday morning; the nurse is coming out to administer here at the house. I will drink lots of water ahead and have Gatoraide on hand.

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
ALJ approval/denial rates pme Disabilities 16 10-01-2011 07:44 AM
Dire needs cases after approval elocin0482 Disabilities 25 08-18-2011 01:00 PM
Tips on SSDI approval! emeadows Disabilities 3 06-12-2011 04:34 PM
Getting the run around mscat40 Disabilities 5 04-06-2011 07:03 PM
SSDi approval-W/C and lawsuit lisa3451 Disabilities 5 03-16-2011 02:12 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Sign Up Today!

Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

I want my free account

All times are GMT -7. The time now is 11:59 PM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!