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. During the initial evaluation of the case, Social Security will request your medical records from your treatment providers at no cost to you. This is why it is very important to provide Social Security with the most complete information about the doctors you are treating with, their names, addresses, and telephone numbers.

Also, it is a good idea to stayed in touch with the Disability Determination Services office in your state to make sure they are requesting, and receiving, these records.

If you are already past the initial evaluation step in your case, that is if you have already received your initial denial, it may be a good idea to work with an attorney to help limit what records you are requesting.   There are a couple of reasons for this:

In my experience handling Social Security disability cases in Colorado, Social Security rarely requests medical records  after the initial determination.   Occasionally, I see some judges requesting medical records.   But this is pretty rare, and only in cases where the claimant is not represented by counsel.

Doesn’t this mean that I can get Social Security to get my medical records at no cost to me if I simply don’t hire an attorney?

Well, no.  There is no guarantee that Social Security will get updated medical records. Additionally, you have no control over what records Social Security will try to get, or how far back they will go.

By working with an attorney, you can determine which doctors records are essential in your case, and which ones are not. The lawyer can also help you determine how far back the records should go, and most importantly, what records to specifically leave out of the request to keep costs to a minimum.

If you request all available medical records within a certain period of time, maybe a third of the records will actually be useful and relevant. The remaining records may be unnecessary lab results, physical therapy notes, nurses notes, or medication logs.   This is not to say, these types of records are always unnecessary, but frequently they do not add very much to building up a case. 

Remember: when you request medical records, you pay by the page. So, the more pages you receive (relevant or not) the more you pay.

Your lawyer can help craft a medical records request that will weed out the unnecessary pages, give you the most relevant records, and save you money.

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.

The same regulation states, “No fees shall be charged by a health care provider of patient records for requests for medical records received from another health care provider or to an individual regulated pursuant to Section 25-1-802(1) solely for the purpose of providing continuing medical care to a patient.”

This means another of your doctors can request and obtain medical records at no cost, if it solely for the purpose of providing continuing medical care.

This allows your new doctor to obtain you records from your prior doctor.  This also allow one of your current doctors to get another of your current doctor’s records so that he or she is kept up to date about your treatment.

The long and short of it is that your doctor can get your records for free.

How does this help you?  Once your doctor has gotten the records, your doctor can provide you with copies at no charge or a very minimal charge.

Obviously, your doctor cannot request the records for the purpose of providing them to you.  But, if the purpose was solely for providing continuing medical care, once the records are in the doctor’s possession, the doctor is not obligated to charge you for copies of the records.

The gotcha is that you have to have a doctor who is enough on your side to provide copies of the records in his/her possession to you at no charge.  In practice, this does not happen too often.

However, if you have a doctor who is very supportive of your Social Security claim, your doctor can save you A LOT of money by helping you get your medical records.

Note:  this is Colorado specific, but other states may have similar regulations.

The State of Colorado has allowed medical records copiers to increase the prices they charge to provide your medical records.

Medical records are one of the foundations of a Social Security case. The main way you establish the existence and severity of a medical condition is through medical records. ALL attorneys whose practice revolves around medical records are going to have to swallow this price increase. It also means that your costs as a client are going up.

Do not blame your attorney. The money is not going into your lawyer’s pocket; it is going to the medical copiers.

The maximum medical record providers are allowed to charge in Colorado is set by 6 C.C.R 1011-1, Chapter 2, Part 5.2.3.4. In 2007, the maximum price was “not to exceed $14.00 for the first ten or fewer pages, $.50 per page for pages 11-40, and $.33 per page for every additional page.”

In 2008, that has jumped to “$16.50 for the first ten or fewer pages, $.75 per page for pages 11-40, and $.50 per page for every additional page.”

What’s the big deal, it’s just pennies? Right?

Wrong. It is a big windfall for medical copiers.

Lets says you get 50 pages of records from one doctor. In 2007, you would pay $32.30 plus postage.

($14.00 for the 1st 10 pages, $15.00 for pages 11-40, and $3.30 for pages 41-50)

In 2008, you pay $44.00. More than a 36% price increase!

($16.50 for the 1st 10 pages, $22.50 for pages 11-40, and $5.00 for pages 41-50)

If you get 100 pages of medical records, in 2007, you would have paid $48.80. In 2008, you pay $69.00. More than a 41% price increase!

If you get 200 pages of records, in 2007, it would have been $81.80. In 2008, it is $119.00. More than a 45% price increase!

And it does not stop there; the more records the copier provides, the greater the increase in their prices!

Now, consider how many doctors you have seen for your disability. These prices apply to all of them! Now, doctors could charge less. But, the reason these price “restrictions” were put in place was that doctors’ offices and medical copiers wanted to charge even more.

I realize some, mostly older, records may be in damaged paper files, they have to be separated, un-stapled, copied and then reassembled. Let’s also say that it takes an hour to process 50 pages. Cost to you: $44.00. $44.00 for one hours work!

As my grandpa used to say, “Good work if you can get it.”

Many offices and hospitals are now using digital records systems. What do you think the hourly price is when the records can be pulled up on a computer and then sent to high-speed printer?

What can you do about it? Call your Colorado representative! Tell him or her that the medical records copiers are charging too much and it affects your ability pursue a Social Security claim!

If you do not know what district you are in, click here first. Or give them ALL a call! Do not avoid calling because you are a Democrat and the representative is a Republican (or visa-versa). You pay their salary either way! They work for YOU!