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Failure to Follow Prescribed Treatment: The Importance of Compliance

It is very important to comply with prescribed treatment for your conditions. SSA will agree that your conditions or symptoms are worse when you are not doing the things your treating providers recommend; however, it is harder to be approved if you are not compliant with treatment. This is particularly important in cases with conditions that are expected to be amenable to treatment. Diabetes and epilepsy are two major impairments where SSA evaluates an individual’s compliance with prescribed treatment. In general, a seizure disorder is expected to be well-controlled if an individual takes their anti-epileptic medications as prescribed. Similarly, blood sugars and A1C levels have a better chance of being well-controlled when an individual follows a diabetic diet, and takes insulin or diabetic medications as prescribed.

There are certain exceptions that may prove a “justifiable cause” for not following prescribed treatment. These exceptions are very specific, and you must provide documentation to support that your reason for not complying is “justifiable”. A common reason that individuals are unable to comply occurs when they are unable to afford prescribed treatment. Prior to the Affordable Care Act, many individuals were unable to afford insurance once they were no longer able to work. Now that there is a government mandate requiring everyone to have insurance, if you are no longer working you should go to www.healthcare.gov to see if you qualify for free or subsidized insurance. If you live in a state that runs its own healthcare exchange, the healthcare.gov website will re-direct you to your state-run health exchange: https://www.healthcare.gov/.

Additionally, there are also prescription assistance programs for individuals suffering from diabetes or epilepsy. Check here to see if you qualify for assistance:

  1. Diabetes Prescription Assistance: http://www.diabetes.org/living-with-diabetes/health-insurance/prescription-assistance.html?referrer=https://www.google.com/
  2. Epilepsy Prescription Assistance: https://www.aesnet.org/clinical_resources/treatments/drug_assistance_program

It is very important to make every effort to comply, take medications as prescribed and follow-up with your treating providers on a regular basis.

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