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:
Does Everyone Need to See a Doctor?
Certain types of conditions cannot be treated and do not require medical care. For example, if a person has total, permanent blindness, Social Security does not expect them to regularly see a doctor to treat their blindness.
On the other hand, if you have a condition where there are some kinds of treatments, but they have not been working well or helping you, Social Security expects that you will still continue seeing your doctors.
Also, if you have a condition that has the potential to change over time, or that it is possible to improve from, Social Security will be looking for regular doctors records to monitor your current state.
How Often Do You Need to See a Doctor?
There are no specific rules explaining with Social Security means by “frequently and ongoingly.” As a general rule, you should see a doctor the amount your doctor recommends for your condition. Some of our readers report that they see their doctor at least once every three months for physical health and every month for mental.
No matter how long it has been since your last doctor appointment, and no matter what the reason is that you stopped going to the doctor, the very best next step you can take is always the same: immediately start seeing a doctor again, if you are at all able to.
Even if there is a gap in treatment in your past, having new current records can make a great difference for your disability applications or reviews. A few ideas for troubleshooting doctor visits:
Finances and Insurance
Ideas for helping pay for the doctor:
- If you can’t afford doctor’s visits
- If you can’t afford medications
- If you got turned down for Medicaid or think you don’t qualify
Transportation & Leaving the House
In some areas, there are services available that will send a doctor or nurse to your house. This is sometimes be covered by insurance. Some insurance companies will also pay for online sessions with a therapist or psychologist. Where to Find Home Doctor Visits
Services that may be able to help you If you don’t have transportation to the doctor
Some of our readers report that they stopped seeing a doctor because the treatments weren’t helping their condition or were causing severe side effects.
If this is your situation, one option is to talk to your doctor about finding a new kind of treatment. Another option is to talk to your doctor about the severity of your side effects and ask their medical opinion. If your doctor writes that they do not recommend medication for you, then Social Security would see that as a valid reason for not taking medications.
Some readers find it helpful to let their doctor know that even if treatment is not possible, they still need to keep up periodic doctor visits in order to document their condition for disability.
Explaining Good Cause
Social Security policies will accept if you did not see a doctor or follow treatment for a good reason. However, if you stop treatment because you do not like the doctor or do not like the treatment, this can sometimes cause problems. Learn More: What is Good Cause? What is Not Good Cause?
If you are applying for disability, 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. It can be a great help if you can collect records yourself yourself and submit records yourself.
If you had a doctor in the past that was supportive, but you had to stop seeing them when your health insurance or money ran out, some of our readers found it helpful to try going back for just ONE visit and paying for it yourself if you are able. During this one visit, beg them to fill out an RFC Function Form for you. This form is the single most important thing that can help your disability application.
Many doctors don’t like filling out paperwork, so before asking for any forms, it may help to read this page: How to Deal with a Doctor Who Does Not Like Disability Forms
It is also a good idea to research any free programs that might be available in your area: If you can’t afford doctor’s visits
Disability Update Reports (Short Form Disability Review)
If you are already on disability and received a short form review, you will likely receive a full Continuing Disability Review some time in the next year. Also see below on explaining good cause. How to Prepare for a Social Security Disability Review
Continuing Disability Review (Long Form Disability Review)
If you are already on disability and received a long form review, it is likely that you will be sent for an appointment with a Social Security doctor. Learn more about How to Complete a Continuing Disability Review. If your review is not approved the first time, please take a look here: How to Appeal a Continuing Disability Review. Also see below on explaining good cause.
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.
If you are looking for a new doc, here’s some ideas for How to Find a Doctor to Help With Disability Documentation
🌷 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
If you have a reason why you have not been seeing a doctor, you can put this in the remarks section of the form you are filling out, 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 be helpful:
- 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.
💮 The Sleepy Girl Guide to Social Security Disability
💮 How to Have Doctor Visits That Create Accurate Records
💮 Everything You Need to Know About Social Security Disability Reviews
💮 Art on this page by Robin Mead and Elizabeth D’Angelo.
💮 Page Updated: 7/1/19
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5 thoughts on “How To Explain Why You Haven’t Been to the Doctor”
I was raised by and am still living with naturopathic quacks who refused to take me to a doctor, psychiatrist, etc. They think they can solve everything through diet, supplements, and various air frequencies.
It obviously hasn’t worked and now they are poor enough that they wanted me to apply for SSI so I could pay them rent.
I told SSA this and they got me assessments. So my only evidence is those assessments thanks to my family’s medical neglect.
Thank you for ALL that you do, which helps so many of us.
I usually go to the urgent care. I can’t make it to appt., so I only go if it is something they can treat. They have late hours, which is very helpful for me. The problem is that I haven’t had care for my Fibromyalgia, I don’t get anything done yearly, I am way overdue on important procedures and sometimes that scares me.
Go to the emergency room for anything that can be observed and treated there as long as it is something provable like ear throat or urinary infection or some other condition they can SEE and will give you a script for….
When they see a series of visits if even over some years it makes a difference.
Thank you Kim. I wish that everyone had insurance and did not have to do it this way, but this is a good suggestion for someone who doesn’t have any other options.