How To Explain Why You Haven’t Been to the Doctor

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Social Security likes it when you are seeing your doctor “frequently and ongoingly” and following all your doctor’s treatment recommendations. Easier said than done. If you have not been able to get to the doctor, here’s a few ideas for good next steps:

 

Get Creative

Out-of-the-box ideas for getting to the doctor when you can’t get to the doctor:

 

Collect Old Medical Records

If you have great medical records from the past, but stopped being able to go to the doctor, Social Security may be willing to consider your past records.

If your records are more than three years old – Social Security will not collect these records. If you want them to see these records, you will need to collect them yourself and submit them yourself

If your records are less than three years old – Social Security or your lawyer should collect these records. Notice the use of the word “should” in that sentence. If you want to be sure they will see these records, you will need to double check that your records are really there

 

Explain Good Cause

If you cannot get regular medical care now, it will be harder to get approved, but it is still possible. Social Security has a policy that this is acceptable if you have a good reason.

Being broke and having no health insurance is a good reason. Or having health insurance with co-pays and deductible you cannot afford.

Being homebound or unable to travel because of your health is also a good reason, but you will probably need some type of provider who can write a statement for you confirming this.

Some people have conditions that cannot be treated. If your doctor has written that no treatments are available for your condition, this may be considered good cause.

Depending on your circumstances, there may be other good reasons. For example, I know one man who was unable to get to the doctor after his mother died, since she was his caregiver and had taken him to the doctor and scheduled all his appointments. He was unable to get to the doctor on his own. He got a letter from his brother confirming this, and Social Security accepted this as a good reason.

If you stopped seeing your doctor because you did not like your doctor, or did not like what your doctor said to you, or you did not like their treatments and medications, Social Security will expect that you start a new doctor. If you decided to see NO doctor for this reason, this could cause a lot of problems for your case.

 

Put it in Writing


Whatever your reason is, make sure to write down your reason down on your Social Security forms. You can put it in the remarks section, or you can send them a brief letter (a few sentences is fine).

If you can get to the doctor, but can’t fill prescriptions, you can tell your doctor that you cannot afford it and — this is the important part – politely request to your doctor writes down that this is the reason in your records. Also, write it down yourself on your Social Security forms and write down any steps you took to try to find free or discounted prescriptions.

If you can provide Social Security with any proof, that is even better. It does not have to be fancy. For example, if you are uninsured and cannot afford to see a doctor, any of these things might do the trick:

  • Copy of denial notice for Medicaid
  • Copy of notice of health insurance ending
  • List of any places you called trying to get free healthcare and what each place told you
  • If you are on a waitlist somewhere, copy of waitlist notice
  • List of price quotes for medication you need or price quotes you got for doctor’s visits and financial info to show you can’t afford it
  • Letter from a friend or relative confirming that they saw you or helped you try to contact doctors but could not find any services that were available

 

 

 

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