What medical records cost in your state
Here is a great site that lists all of the medical record charges by state. I have previously written about what it costs to get your records in Colorado. Colorado’s regulation is contained in 6 C.C.R. 1011-1, Chapter 2, Part 5.2.3.4
5.2.3.4 Unless otherwise prohibited by law, a representative of the patient, other than a “personal representative” as defined in the Federal Health Insurance Portability and Accountability Act (HIPAA) § 164.502(g), with the patient’s written authorization, shall pay for the reasonable cost of obtaining a copy of the patient’s record, which shall be $16.50 for the first ten or fewer pages, $.75 per page for pages 11-40, and $.50 per page for every additional …
Social Security consultative examiner speaks out
Ever wonder what Social Security consultative examiners – the doctors who meet with disability applications to decide if they are disabled – think of the Social Security disability process?
Writing in Guernica, Dr. Heather Kovich discusses her experiences as a (former) Social Security disability examiner:
There is also a stereotype of the doctors who do this work: lazy and disinterested. I found the job fascinating. The more I learned about the disability system, the more I pondered its complexities: it provides a safety net but keeps people mired in poverty. Helpful services, including job retraining, are available, but aren’t advertised. And the system rests on a deeply flawed premise—that there is a way to objectively determine who is able to work and who is not.
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This was my job, “independent medical examiner.” On the basis of a forty-minute interview and examination, I was supposed to determine how disabled an applicant or “claimant” was.
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I did hundreds of disability exams over the next year, and while I did meet two people who were obviously faking, for the most part the stories I heard were heartbreaking: car accidents, massive strokes, lost jobs, dead spouses. Many people who apply for disability have lived through a tragedy. But the stories also told of the inefficiencies of the disability system. That first day in Spokane I met a man who had worked in manual labor his whole life, but for years had been getting crushing chest pain after walking a few blocks. His blood pressure was dangerously high. His condition was obviously treatable, but he did not have insurance so he had not been to a doctor in years. He knew that if he qualified for permanent disability he would eventually get Medicare or Medicaid and get proper treatment. He had no idea he could go to a community health center, a federally financed clinic where he could pay on a sliding-scale basis. With the right treatment and a less strenuous job, he would probably have not needed disability. Emphasis added.
This is the catch 22 of the Social Security system: with the health insurance Social Security provides, you might not be disabled. However, without Social Security disability, you can’t get the medical care you need.
This isn’t strictly a Social Security problem, it is US health system problem.
Social Security denied me disability benefits using a doctor of WHAT?
Social Security has physicians review disability cases as medical consultant’s to make opinions on individual’s abilities and limitations. However, what good is the medical consultant’s opinion if they don’t have expertise in with the disability in question.
Per Nate Craig:
… you may also want to look at the Medical Consultant’s Code attached to the State Agency’s opinion. I am finding more and more reviewing physician’s making opinions outside their professional field. Recently an ALJ relied on the State Agency’s opinion where the initial decision was made by a SDM and then affirmed by a “dermatologist” MCC of 6. The AC kicked it back with the directive for another physical CE. At the remand hearing, the same ALJ entered a decision of disability back to original onset date.
Penrose St Francis Hospital blocking faxed records request
Penrose St Francis Hospital, one of the two major hospitals in Colorado Springs, sent me the following canned response to a (faxed) request for records for one of my clients.
Please note that the fax number you are sending your request to is for physician use only.
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Medical records requests from law firms need to be mailed to our facility in order to be processed.
Penrose St Francis is refusing lawyers from faxing requests for medical records. Penrose St Francis has a fax number for requests. They even use an third party medical copying service for processing record requests (so, it is not like nurses have to take time out from helping patients …
Do you have to give bad evidence to Social Security on your disability benefit case?
One of my colleagues in the fight to help disabled individuals get their Social Security disability benefits, attorney Johnathon Ginsberg, tackles whether you have to submit unfavorable medical evidence to Social Security.
I see this frequently in cases where there was a workers’ compensation case. “Company doctors” often minimize symptoms and generate records indicating that a claimant has the capacity to return to work. Other times I see unhelpful records in cases where my client just did not “click” with his or her physician or psychiatrist.
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I do not believe that a claimant or a claimants attorney has any obligation to submit unhelpful medical records. This issue periodically comes up on listservs that go to claimants lawyers and the general consensus among most attorneys seems to be that an attorneys obligation is to represent his clients zealously, meaning that there is no affirmative burden for that lawyer to submit unhelpful information. I do know some lawyers, however, who take the opposite position, but it appears to me that they are in the minority.
Even Social Security judges encourage attorneys not to submit every scrap of paper when representing a claimant on a Social Security case. I have attended continuing legal education programs where administrative law judges suggest that attorneys do not submit evidence if it is not relevant.
But there is a crucial difference between not submitting irrelevant evidence, and not submitting unfavorable evidence.
My Social Security file is missing records
Let’s say you are reviewing your Social Security exhibit file before your disability hearing and you discover that some of your doctor’s (or other records) are not there. I have mentioned before that it is not unusual for the medical records in a Social Security file to be a year or more out of date.
What can you do if the records are not complete?
You can ask Social Security to update the records. If you do not have a lawyer Social Security has a higher responsibility to make sure that your hearing is fair, which includes …
What is a rheumatologist?
The American College of Rheumatology has a great overview of what a rheumatologist is and when you should consider seeing one.
A rheumatologist is an internist or pediatrician who is qualified by additional training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. Many rheumatologists conduct research to determine the cause and better treatments for these disabling and sometimes fatal diseases.
What Do Rheumatologists Treat?
Rheumatologists treat arthritis, certain autoimmune diseases, musculoskeletal pain disorders and osteoporosis. There are more than 100 types of these diseases, including rheumatoid arthritis, osteoarthritis, gout, lupus, back pain, osteoporosis, fibromyalgia and tendonitis. Some of these are very serious diseases that can be difficult to diagnose and treat.
When Should You See a Rheumatologist?
If musculoskeletal pains are not severe or disabling and last just a few days, it makes sense to give the problem a reasonable chance to be resolved. But sometimes, pain in the joints, muscles or bones is severe or persists for more than a few days. At that point, you should see your physician.
Seeing a Rheumatologist in a Social Security case:
Seeing a specialist can often be critical in the Social Security case.
How to diagnose fibromyalgia
It can be very difficult to win Social Security disability benefits based on fibromyalgia. However, it can be done!
While Social Security no longer considers fibromyalgia as a “imaginary” condition, or a “junk” diagnosis, you still need to make sure the diagnosis of fibromyalgia is backed up by medical findings.
I have reviewed many medical records which mention fibromyalgia, but don’t say how the doctor made the diagnosis. There is no mention of physical examinations or findings. Social Security may throw out the diagnosis because of a lack of medical support.
Without a diagnosis, all you have are symptoms and Social Security cannot approve disability benefits on symptoms alone.
This can stop a case dead in its tracks!
So, what do you need to properly diagnosis fibromyalgia?
Should I see a specialist when applying for Social Security?
I am often asked whether seeing a specialist will help in a Social Security disability case.
Do I need to see a specialist? I have my own doctor. What else can a specialist tell me about my case? How can they help?
I have seen numerous cases where Social Security has downplayed the opinion of a treating physician because the doctor is not a specialist!
I have even seen some cases where the Judge rejected the primary care provider’s opinion at hearing because he thought the doctor was just “saying what the patient wanted the doctor to say.”
A lot of these problems can be eliminated with a specialist’s evaluation and medical opinion.
What if your doctor does not want to help your Social Security disability case?
eNewsMediaMagazine has some tips on building a strong Social Security disabilty claim:
Tip #1: Choose the right doctor(s).
Regardless of your specific disability, you will need medical documentation. The only way to do this is to visit at least one physician. Ideally, that would be an experienced, respected doctor in the field of your disability. The more specific the doctor to your disability, the more credibility he or she will have. For instance, if you claim to have back problems, but only see an MD for treatment, your records will probably not contain much useful information other than pain medication.
There is nothing wrong with this tip. However, for many people choosing which doctor they see, just is not an option.
Does Social Security set a maximum fee for medical record charges?
The answer to this is “yes,” and “no.”
When Social Security requests medical records from a treatment provider (doctor, hospital, walk-in clinic, physical therapist, chiropractor, etc.), and they put a cap on how much they are going to pay for those records.
Unfortunately, they do not put any cap on how much the medical records provider can charge you if you request the same records. I have previously written about how much treatment providers can charge for medical records in the state of Colorado. Other states have similar laws in place setting the maximum for medical record charges. However, Social Security gets the best deal when it comes to requesting medical records.
You can use this to your advantage.
Social Security Consultative Examinations
Here are some common questions I hear when Social Security schedules an evaluation or examination with one of their doctors:
Do I have to attend the consultative examination?
Since you are applying for Social Security benefits, you have a duty to assist Social Security in obtaining the information it needs to evaluate your case. This includes going to evaluations or examination that Social Security may schedule for you.
So, “yes,” you do have to go the examination.
Of course, Social Security cannot make you attend a consultative examination. But if you do not attend, your case may be denied, or even dismissed.
What if I cannot attend the consultative examination?
If you cannot attend, contact Social Security right away.
Secrets of the Social Security Consultative Examination
Has Social Security sent you to a doctor for an examination? Here are some things you should know when going to a consultative examination.
The examination begins earlier than you think:
You are observed from the moment you enter the office.
The observation continues in the waiting area and you may even be observed when you walk back to your car.
The examination may include how you walk from the waiting area to the examination room and your ability to climb on and off of the examination table.
Your behavior may then become part of the doctor’s report to Social Security.
In my experience, the chance of a Social Security consultative examination proving that you are disabled …
Social Security disability tip: how to get your medical records for free!
If you request medical records from a doctor or hospital in Colorado, the maximum you can be charged is set by 6 C.C.R 1011-1, Chapter 2, Part 5.2.3.4. In 2008, the maximum price for medical records is “not to exceed $16.50 for the first ten or fewer pages, $.75 per page for pages 11-40, and $.50 per page for every additional page.”
This can quickly add up!
But, there is a way to get your medical records for free.
Another use for ALISON: has your doctor been suspended?
ALISON (Automated Licensure Information System Online), is the online licensing database for the state of Colorado. I previously wrote about how this site is a great resource for finding an address for your doctor.
This site also has another use. If your doctor has been suspended, this will show up ALISON.
