Should a medical provider charge a $350 fee for completing paperwork to help a Social Security disability claimant? Remember, Medicare or Medicaid benefits go along with Social Security disability benefits. A patient who loses their Social Security disability appeal may lose medical coverage or be forced onto Medicaid which reimburses providers at a lower rate. Is the $350 fee reasonable? What about filing health care reimbursement forms? Should providers charge separately for doing that? It's not medical care either.
If you think that attorneys who represent Social Security disability claimants are so wealthy that they should easily be able to absorb fees like this, maybe you ought to ponder this question. Why is it that virtually no one leaves the employment of the Social Security Administration to represent claimants before the agency? If it's lucrative, wouldn't you expect there to be a steady stream of people doing this?
I live in a Red State, and have recently experienced this with both SSD and WC. Physician charges have been as high as $400.00 and $375.00, and of course, new physician reports are needed with each appeals step with the same charge again, etc., so this rapidly rises. Believe it, or not, this is preferable over that which is now the norm, i.e., the vast majority of physicians 100% refuse to complete any reports, forms, or letters no matter what, and they are resolute, no matter the patients circumstances, length of treating relationship, or offering even more money for the physician to complete another report, letter, or form.
ReplyDeleteKnowing there is some danger involved in just telling the disabled to drop dead and eliminate the program entirely, a good stealth approach is to inflate or price them out of existence. Medical records are going to become so expensive that claimant's will be unable to obtain their year or two worth waiting for hearing. Medical source statements will become a Cadillac luxury for the few fairly well off that get stuck in the system. Reps will be frozen out by denial rates, fee deflation or no longer withholding fees. Finally. the seven hundred in change for SSI or the $1200 or so average for SSD will by you a loaf of bread, a can of pork and beans, and a Coke and a smile. Don't count on the calvary coming anytime soon either, the good old reliable Washington Generals dems are already working on blowing the midterms by not doing things like aggressively calling the swamp scum out that are doing all of this. The Globetrotters will come back to win in the final minutes by at least a few baskets because of the glorious economy that will go to hell sometime later in the Trump second term.
ReplyDeleteThe real problem is that the checklist form or one sentence saying the claimant is disabled is useless and makes your case look weak to the ALJ.You would be much better off getting them a full objective FCE at a rehab hospital or provider.
ReplyDeleteThis has been going on for years. I spent a decade at one of the national SSD-rep factories, and these charges routinely came over the transom. Before the "treating physician rule" got eliminated (the drafting of which occurred under Obama's term), too. I saw these charges 20 years ago. You also had doctors charging $500/hr for rep-ordered CEs, too, although I don't see those kind of reports anymore.
ReplyDeleteBasically, doctors want in on the money reps are perceived to earn.
Of course, the paradigm of the solo practitioner mashing $200K/year with a cushy SSD practice is now over; the national factories and their hedge fund investors keep the profits now, and the attorneys who actually appear in court are per diem hires trying to low-bid each other, while forgetting which of the six or seven companies they're appearing for that day.
Disagree that virtually no former SSA employees are representatives. There are a lot of former SSA employees, mainly retirees, who have become Claimant Representatives. NADR as an example, has a significant membership and I would assert a statistically significant number are ex SSA employees. As far as the $350 charge for medical records, I consider that morally reprehensible and have told several physicians it is unacceptable. Some have patients for years who have paid thousands of dollars to their practice. If a patient is disabled, a letter from a treating MD is reasonable. Also, I don’t believe 100% of physicians refuse to complete any reports, leters. I routinely receive medical records and specific reports. Yes, they are a hassle for a treating MD. But one can articulate the necessity of such reports with a little bit of poise.
ReplyDeleteHaving said all that, the disability program has gone to hell and there is little support nationally. Who is to blame, is debatable. However, media reports by insufficiently informed or biased journalists have been integral. Congress is clearly the main offender. The public also must share some blame. Disability benefits are not a priority issue, and pressure on Congress has been minimal. I don’t think all is lost. Having been in the field for 30 years (both as an SSSA employee and as a representative), a pendulum swing back towards the more compassionate program days of adjudication is possible. Hope springs eternal.
Statistics show that senior attorney advisors are not very productive at SSA. So, why would they leave a job where they get six figure salaries and do very little work to take a job in the private sector where they would have to actually work every day to earn their pay?
ReplyDelete@6:58
ReplyDeleteYou sound envious of Senior Attorneys. For your information, Senior Attorneys do much more than write decisions for ALJ’s. It takes time to screen cases, and many Senior Attorneys draft a brief report to the ALJ about the information they have learned about each case, even the ones which are not recommended O-T-R’s. My reports include a brief synopsis of the Facts; a list of “severe” and “non-severe” impairments; recommended RFC/VE Hypo; and whether additional evidence, or a CE should be requested. Senior Attorneys are also often tasked with special assignments requested by ALJ’s on novel cases, which you know nothing about.
Thus, Senior Attorney work performed well and as intended cannot be measured by metric quotas. Further, most Senior Attorneys more than paid their dues as a Staff Attorney for several years, and were selected to be Senior Attorneys because they were highly productive and performed exceptional work as a Staff Attorney.
Degrading your fellow Senior Attorneys is unprofessional, lowers morale, and looks poorly on you. In other words, it serves no useful purpose.
"Social Security will not challenge the legality of the doctor’s opinions, she said" What in the world could she possibly mean by this?
ReplyDeleteDegrading any attorney is an American tradition, get over it~
ReplyDeleteI’m impressed by both the quality of reporting and the representation.
ReplyDeleteAs a skilled union labor, this claimant probably has a pretty substantial PIA. It sounds like the judge had already accepted that disability had gone back to at least 2016, the year of diagnosis. For the representative, accepting an amended onset date like that would make no difference since the maximum fee would likely already be reached. But this representative, from what I’m gathering, was interested mostly in the claimant’s Medicare eligibility (which as we all know usually kicks in two years and five months after AOD).
The representative did more than just argue with the judge for the original onset date ( which itself would be admirable ) they fought tooth and nail with the health facility for, I’m assuming, no personal gain.
This is very heartening to see. Your client should always come first.
@2:12 stated, “degrading any attorney is an American tradition.”
ReplyDeleteThis is not true in the workplace, especially among fellow attorneys. It’s easy to see who has the real “attitude” problem here concerning Senior Attorneys.
I sure hope TPTB in SSA-OHO read this blog and the comments, so they can see how low they have stooped in hiring and management. An attorney with your attitude about your colleagues would not have been tolerated at this Agency a few years ago. Now, it is not uncommon. We must all ask ourselves why? I maintain it is the manner SSA-OHO is currently run and managed, which not only fosters, but entices, this type of unacceptable behavior among employees, including those with advanced degrees, and is ripe for the toxic work workplace on the rise in many of this Agencies Offices today.
No, $350-$500 is not reasonable, especially for what reps typically receive in my area. 80-90% of the claimants have extreme limitations in every MRFC1 area, can't lift anything, can't sit/stand/walk for more than 15 minutes in a day, would need six two-hoir breaks in an 8-hour day, etc. Or they'll simply say "per the patient, he can do..." There are also reps that I suspect fill out the forms for the docs to sign since every local provider seems to give the exact same limitations for every one of their clients.
ReplyDeleteThe helpfulness of treating source statements, even back in the day of 96-2p (which a few reps are still arguing in briefs), was very limited given the product they'd put out.
There are at least three reps in my area that are former SSA employees (non-retirees), though there are more former reps that have joined the ranks of federal employment since I've been around.
After reading these comments, I sent the following message to my Rheumatologists' office. Their response is first:
ReplyDeleteRE: Medical Question
Mr. Xxxxx,
I am sorry that you are not doing well. It sounds that you are depressed and should see a psychiatrist; I can refer you to see a psychiatry at xxxx if you don't have a psychiatrist. You may make appointment with your neurologist for headache.
Your ankylosing spondylitis was quiet when I saw you at end of March. Your pain is from fibromyalgia but you couldn't tolerate sleep machine and did not benefit much from medications Cymbalta or Lyrica; I discussed with your attending Dr. Xxxx and we think you may benefit from seeing a pain psychologist to learn therapies for coping with pain. I suggest you find a pain psychologist close to where you live, I can refer you if referral is needed.
To: Patient Medical Advice Request Mailing List
Subject: Medical Question
Hello,
Can anyone there help me? Everytime I see my rheumatologists, it depresses the hell out of me! I know that neither one of them will help me. It's been over 4 years since I was last able to work. The medications simply don't help enough for me to work. They say people on fibromyalgia shouldn't be on disability, yet I cannot work. I try to exercise, but the pain just limits how long I can do anything. It takes me days sometimes to recover from just a little simple exercising. There have been times when I walk to the car and my back hurts so much that I wanted to die. My shoulders ache and raising them hurts not only my shoulders but my back. My thumbs are very painful. The rest of my fingers feel sort of numb and yet stiff as if I'm wearing a pair of gloves. My eyes are easily irritated and they give me migraines these migraines can last 10 to 15 hours and the medication I have only work so well I still have incredible eye pain even if the migraine is lessened. The surgery I
had for my eyelashes has helped,but, I still get lots of headaches and migraines. For example, in the last two weeks, I have had four migraines and at least two other headaches that lasted for several hours. I vomited in one of those migraines and got very nauseous a couple other times. I get depressed often and many times, I have thought about ending my life. However, I owe my brother too much money to do that. He is my landlord and I owe him. Sometimes when the depression grips me, I get this tightness in my chest and in my abdomen I get something like cramping; my breath gets shorter. I applied for Social Security disability. However, I was denied by the judge after the hearing. My doctors refuse to help me. Two of them, my rheumatologist and general practitioner, fired me as a patient. My newer general practitioner wouldn't help me either. Now she's going to the ER. I don't know what to do. I'm depressed and and I feel hopelessness. I just don't see anything changing anytime
soon. Can you help me please? Thank you, Tim
Tim,
ReplyDeletePlease retain an Attorney. It will be worth the cost in back benefits. With appropriate and experienced legal counsel, you are more likely to win your case. It will not cost you anything, unless you win.
Hard to find a rep to take a case after it has been denied through AC.
ReplyDeleteI had an attorney for AC. They decided not to take to Federal Court. I have called or emailed 30-40 law firms. None were interested. One lawyer did talk to me...
ReplyDeleteI received a package from SSA. It had all my medical records, etc. It was well over 1000 pages! It just begs the question. What more do you want? What more could I have done? Is there any way of of this hell other than death? I have lost the ability to deal with this, let alone the pain. I know I can't do the jobs the ALJ claimed I could. I just thought some of you need to know what this does to people.
I'm a former senior attorney who left to become a rep a couple years ago. I definitely gross way more now than I did as a senior attorney, but the net hasn't quite balanced out yet. I know I work way harder now than I ever did as a senior attorney. I also have much greater job satisfaction and respect in my legal community. It's hard to put a price on that. However, I often say to my friends that you have to be a little touched to hang out a shingle in the first place. It takes so much nerve, hard work, long hours, networking, and drive to build a practice, that it does not leave much time for anything else. I think a lot of people go into a stable federal job becuase they are looking to have time for other things. That may explain more of why you don't see a mass exodus more than anything about compensation.
ReplyDeleteIn my opinion, the agency doesn't properly utilize attorneys either regular or senior attorneys. The job is low level attorney work and compensated way above that point partially to make up for the monotony and lack of opportunity in the job. To move up the ladder, you have to basically give up being a real lawyer and become middle management which is a completely different set of skills than being a good attorney.
Plenty of doctors fill out forms for me for free. I use the Thomas Bush forms which are 6 pages long and have plenty of space for doctors to write in comments. Many judges find them useful. The ones that aren't useful are the ones that aren't accurate. I always tell a doctor who asks to call it like he sees it. Many do. I haven't had many doctors ask to charge me $400 or more for a report. The key is to let them know their patient will be paying for it, often directly. Usually asking the client to ask his doctor for it himself/herself rather than asking the doctor directly implicitly makes this point and gets the doctor to do it for free.