Social Security likes it when you are seeing your doctor “frequently and ongoingly” and following all your doctor’s treatment recommendations. This is true before you apply, while you apply, and after you get approved. It is true forever!
Easier said than done. If you have not been able to get to the doctor, here’s a few ideas for good next steps:
Start Right Now
If you have not been seeing your doctor regularly, try to change this as soon as you possibly can. If you are able, call right now and make an appointment.
Out-of-the-box ideas for getting to the doctor when you can’t get to the doctor:
- If you can’t afford doctor’s visits
- If you can’t afford medications
- If you don’t have transportation to the doctor
- If you are homebound or unable to travel for health reasons
- If you got turned down for Medicaid or think you don’t qualify
Collect Old Medical Records
If you are applying for disability (not already approved) and 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.
Social Security does not always collect all your records, especially if they are from years ago. If you want them to see these records, you can call the person handling your case and ask which records have been collected.
Your lawyer also may not collect all your records, or may wait until a year or more after you first apply before even beginning to collect your records.
If you are already approved and being reviewed, they will be looking for more recent records.
Explain Good Cause
Social Security has a policy that they may accept that you didn’t go to a doctor if you have a good reason. You can explain your reason on your disability forms, and when you meet with your doctor, and when you meet with a Social Security doctor.
Social Security may consider some of the following reasons to be good cause:
🌷 Being broke and having no health insurance and no free medical care available in your area.
🌷 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.
🌷 If you have a condition that cannot be treated and your doctor has not recommended that you not have more appointments. You may need a written statement from a doctor to confirm this. For example, if you are permanently blind with no possibilities for treatment or recovery, there is no reason you would continually need to see a doctor about your blindness.
🌷Depending on your circumstances, there may be other good reasons. See some examples from readers below.
Not Good Cause
Social Security will not consider it good cause 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, or you felt they were not helping.
If you do not feel your doctor is helping you, you always have the right to find a new doctor. Switching doctors is not the same as seeing no doctor at all.
If you decided to see NO doctor for these kind of reasons, this could cause problems for your case.
If you change doctors, it’s important that your new doctor be an Acceptable Medical Source. For example, it may cause problems if you stop seeing an MD and start seeing only a naturopath or herbalist.
🌷 Orchid had not been to the doctor for two years. She wrote a letter explaining that her mother was her caregiver, and when she died two years ago, she became bedridden and she stopped being able to get to the doctor. She also called the Disability Examiner and explained this. The Disability Examiner requested a written statement from her brother confirming her story. While this was happening, Orchid also arranged for her brother to start taking to her back to her old doctor and started having regular visits. Her review was approved.
🌷 Chrysanthemum had not been to a doctor for three years. She wrote a letter explaining that she had been in an abusive relationship and her husband threatened her when she tried to leave the house and seek care. She attached a letter from a domestic violence case worker confirming her story. She also arranged through the domestic violence agency to start seeing a doctor again. Her review was approved.
🌷 Marigold was homebound and not able to get to a doctor for two years. When her review came, her family arranged a wheelchair and medical transport to take her back for an examination with her previous doctor. It was the first time she had left the house in years, and the trip caused her symptoms to get worse. The doctor wrote a letter explaining her condition. Her review was approved.
🌷 Willow had not been to the doctor in nine months. Her health insurance was canceled and she was homeless and lived in a state where she could not get Medicaid. While she was applying for disability, she explained her reason and showed proof that she had not funds to pay for care. She collected and submitted all her records and tests from the past, when she still had health insurance. She was approved.
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
- Letter from a case worker or social worker or nonprofit agency verifying your situation.
If You Stopped and Then Started
If you needed to stop going to the doctor at some time in the past, but then started again, this may not come up as an issue, particularly if the problem doesn’t even exist anymore.
When you apply, or when you are reviewed, collect copies of all your most recent medical records. Make sure to get full records with treatment notes. Enclose these with your application or review forms. You should also list the names and full contact information for all your providers on the forms.
If Social Security wants or needs to see more than this, or has questions about your past treatment record, they will let you know.
Good cause doesn’t always work. If you are already approved, good cause may work, especially if you start to see a doctor now.
If you are still applying, it’s going to be trickier. Social Security may accept your good cause, but they still can’t approve you unless they have some kind of medical records to base your approval on.
Please do what you can to get copies of old medical records to them, or to start seeing a doctor now, if at all possible.
If you can go back to a doctor you have seen in the past, that doctor may already have files from you and you can continue a pre-existing treating relationship. This may be helpful.
If you are on disability and have difficulty passing your disability review, see: How to Appeal a Continuing Disability Review