I previously wrote about how Social Security may move a case from one hearing office (Office of Disability Adjudication and Review – ODAR) to another to try to ease case congestion and speed up processing.

Usually, there is nothing to worry about when this happens. However, there is something you do need to watch out for. If you are not careful, you could delay the decision in your case, or even reduce your chances of winning.

If your case is transferred to a different hearing office, be sure that you are submitting evidence to the right ODAR office. If you send records to the wrong office, your evidence may not get into the file. This means the judge may miss critical evidence that could make all the difference in your case.  

How to make sure the evidence gets into your file

Social Security is moving to completely digital files. The days of simply mailing records to the right ODAR office are nearly over. In most cases, Social Security requires electronic submission of records.

If you are working with an attorney, he or she can submit records using Social Security’s Electronic Records Express (ERE) service.

If you do not have a lawyer, you can either fax in your records and other evidence, or send your records to a Social Security scanning center to be processed and entered into your file. Either way, you need to add a cover sheet with a Social Security bar code with each submission of evidence. 

Social Security uses the bar code not only to identify your case, but also identify your file so the evidence goes to the right place.

If your case is transferred, you may need to obtain a new bar code to make sure your evidence gets into your file at the new ODAR office. 

How do you get an updated bar code?

Just ask.

If your file is transferred to a different ODAR office, you will receive a notice letting you know this has happened with the new office’s address and phone number. You should also get a new bar code automatically from that hearing office as well.  If you do not get a new bar code, or if you lose it, you can call the new ODAR office and request a replacement.

What if I lost the notice.  How do I find out which office has my file?

If you don’t know which office has your file, just call your local Social Security office or the Social Security 800 number (1-800-772-1213).  

TIP: You may get more up to date information from your local Social Security office.  Several of my clients have gotten quite a scare when they called the 800 number to check the status of their case, only to be told (mistakenly) that there was no appeal on their case. Fortunately, a call to the local office helped clear up the confusion.

Are you struggling with working because of physical or psychological impairments?  Have you stopped working because you just could no longer do the job?

You may be going back and forth on whether to apply for Social Security:

Maybe I will get better.  But, what will I do if I am not able to go back to work?

Filing for Social Security benefits is not something to rush in to.  But, if you are disabled, you should file as soon as you can. 

If you wait, you may loose several critical advantages. These include health insurance, access to medical care and financial support including savings, family or spousal assistance.

All Social Security disability cases require medical evidence.  The longer you wait to apply the greater the chance that your health insurance will run out or that you will be in a worse financial position to get the medical evidence you need.

• If you have health insurance, take advantage of it.  Make sure to take every opportunity to develop severity of your condition:  talk to your doctor about your disability, get tested, and obtain treatment.  The longer you wait after you stop working to treat, the greater the chance that your treatment options will be diminished.
• Tell your doctor that you are thinking of applying for Social Security and see what she or he says.  Having a supporting physician is often a critical part of a Social Security case.
• Get legal help early on.  Once you have started the application, start talking to attorneys.  A skilled attorney can help you gather evidence including statements from your doctor(s) in support of your disability.
• Get your medical records.  While Social Security may get most of the necessary records, you will not know what records they received until the initial decision is made.  If the decision is a denial, you do not get to obtain the missing records and ask for a new initial decision.  Your only option is to appeal and get your case ready for a hearing in front of a judge.  That may take an additional 6 – 18 months (based on my experience in Colorado).

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!

Whether you are working with a lawyer or are trying to get Social Security disability / Supplemental Security Income (SSI) benefits on your own, you will probably be reading medical records at some point.

Here is a quick primer on how a large portion of medical records are set-up.

Most of the medical records I see from doctors in Colorado, whether from primary care providers, specialists, or other doctors use the SOAP notes system. That is, the notes are divided into Subjective, Objective, Assessment, Plan (or Prognosis): S. O. A. P.

• Subjective – this is where the doctor notes what you told him/her. What brings you in today? How do you feel? What are your symptoms? How are you reacting to treatment/medications?
• Objective – this is the signs and findings the doctor can objectively measure. This includes things like x-ray or lab findings, range of motion, or other results or observations.
• Assessment – this is typically the summary of your diagnosis.
• Plan – this is the course of treatment the doctor recommends or any changes to your current treatment or medications.

Not all doctors use the SOAP notes system. Hospitals, eye doctors and other medical providers may use other systems, but by being able to recognize the SOAP notes system, you will have a leg up on understanding what your doctor’s records are saying.

To be found disabled, generally you have to show that you are unable to perform some type of full time work. This is a simplification of the Social Security disability standard, but it is sufficient for this article.

The most common problem in Social Security disability claims is a lack of a statement of limitations from a doctor.

These statements go by different names:

• Medical Source Statement (this is the term Social Security uses).
• Medical Opinion.
• Statement of Limitations.
• Statement of Permanent Restrictions.

Whatever it is called, it tells Social Security what you can and cannot do. Social Security uses this to decide whether you are disabled.

Isn’t there a statement of limitations already in my medical records?

Probably not.

Most medical records contain a description of your symptoms, the objective findings, the doctors assessment, and the treatment plan. Most medical records do not have any statement of your limitations.

Doesn’t Social Security get a statement of my limitations?

They do. But, chances are it will not help you.

If you are reading this, you probably have already been denied. This means Social Security has already reviewed your medical records and formulated a statement of limitations. Since they denied you, Social Security’s statement of limitations is probably not good enough to prove you are disabled.

Even if you appeal, unless you have your own medically supported statement of limitations, you will probably be denied again. Social Security has a statement of limitations saying you can still work and you have nothing to disprove it. Even if their statement is wrong, if you do not have your own statement of limitations, you are at a disadvantage.

Even if Social Security has not yet made a decision on your case, do you really want a Social Security technician who does not know you, or a Social Security doctor who has never examined you, deciding what your limitations are?   Do you want that to be the only statement of limitations Social Security has when they decide your case? Of course not.

The best people to provide evidence about your limitations are your treating physicians. Your doctors know you and how your impairments affect you. If you are working with a lawyer, he or she can help you elicit a true and complete picture of your limitations from your doctors.

Whether you are fighting to get Social Security disability benefits on your own, or with a lawyer, keep in mind that a statement of limitations is a critical part of building your case, and the one element missing in most Social Security claims.

So, how much is it going to cost me to get my medical records? 

The cost of obtaining medical records differs from state to state. In Colorado, where my practice is located, doctors’ offices are supposed to charge no more than the “reasonable cost” of providing the records.

Under Colorado law, the “reasonable cost” is $14.00 for pages 1-10, $0.50 per page for pages 11-40, and $0.33 for every page after that. Plus postage.
So, it all comes down to the number of pages of records you are requesting. If you are requesting 60 pages of records, the cost would be as follows:

$14.00 for pages 1-10

$15.00 for pages 11-40

$6.60 for pages 41-60

GRAND TOTAL: $35.60 for 60 pages before postage charges. (Now you know why being a medical records copier is lucrative business).

Ok, but you do not request medical records by the page. No one says ‘give me 60 pages of my file.’

True enough. When my office requests medical records, we do it by how far back we are requesting records and the types of records we are requesting. This will be the topic of the next (thrilling) installment.

UPDATE:  These prices are now out of date.  Click on the “Medical Records” category for posts discussing the new rates.

How do you get your medical records?  In Colorado, anyone over the age of 18 can get a copy of their medical records by making a written request to their doctor’s office.

If you have only one doctor, or just a couple of doctors, you can simply ask. Sometimes, the records will be waiting for you by the time you are done with the examination. Of course, this is a best case scenario and things get more complicated from here:

• You may have to fill out a HIPAA compliant authorization allowing the doctor’s office to release your records. Unfortunately, while HIPAA provides guidelines of what should be in the authorization, there is no standard authorization form.
• You may have to make a written request to the medical records department.
• You may have to pay for the records.
• If you want to reduce the potential costs, you may have to limit the dates of service you are requesting or the types of records to be released.
• Mental health providers will sometimes refuse to provide their records to the patient because of concern that this may put the treatment at risk. So, you may have to authorize the release of your records to a third party, such as your spouse, parents, or attorney.

Then you have to do this for each and every doctor and/or hospital you want to request records from.

The easiest way to get your records is to work with an attorney who has gotten the kinks out of working with doctors’ offices and can help you get the most relevant records.

In Part 1, we talked about some of the reasons why Social Security may not get all your relevant medical records.

Here is the real kicker: you often only find out what records Social Security has obtained in the denial notice.

In Colorado, where my Social Security practice is located, Social Security used to send out a letter listing what records they had before making a decision. This notice also asked if you had any additional records you wanted Social Security to consider before a decision was made.

I have not seen that notice in years. Nowadays, you get no warning before you receive the decision. Many people contacting my office are surprised to learn that the most important doctors were not contacted or did not provide any records to Social Security.

And if you are denied, you either have to re-apply or appeal. If you re-apply, you have to start from scratch, and you may have to overcome the possibility that Social Security may just look at the prior decision (a denial) and deny the case again.

If you appeal, you may be waiting anywhere from 6 months to 24 months before you have a hearing on your case. That’s right: you may have to wait two years just because medical records were not requested or received.

This is why it is so important not to just leave it to Social Security to get your medical records.

If you just filed for benefits, you may be wondering if there is anything you can do to improve your chances of being approved?

Yes! Get your medical records!

Why should I get my own records? Social Security is supposed to get my records themselves — and that does not cost me anything. Why should I spend my money to get the records myself?

Unfortunately, you probably won’t know if Social Security actually got your records until they make their decision.

While you may have given Social Security the names and addresses of your doctors, AND signed authorizations allowing your doctors to release information to Social Security, there is no guarantee that your records will actually get into your file!

Wha?!?

Here are some possible scenarios:

1.  If your treatment was more than 12 months prior to your date of application, Social Security may not even request those older records.

In my experience, Social Security tries to get the most relevant records. Which records are the most relevant? The most recent records.

So, records of that car wreck five years ago, or that 72 hour hold for suicidal ideation three years ago, or the records from the neurologist who diagnosed your fibromyalgia when you were 20, Social Security may not even try to get those records.

2.  Social Security just requests the records, it is up to the doctor’s office to actually provide them.

If the request gets lost in the mail, or if your doctor’s office misplaces the request, or ignores the request, Social Security won’t get your records.

Social Security may make repeated requests for records, or it may make one attempt and leave it at that. If the doctor’s office does not provide the records (or provides incomplete records), Social Security is not going to try too hard to get them. From their perspective, there are just too many cases to handle to try to get hard-to-find medical record.

So, the only way to make sure Social Security gets all your records, is to get them yourself.