charging for disability forms and medical records

[Agast]

And when they ask why what’s ur answer? Also, where do you direct them to go to get it done?

I refuse to argue with patients and will straight up tell them “I feel like you’re arguing with me and I’m not sure why, this is not a negotiation.” If they are not happy with the plan of care they are encouraged to seek a second opinion. I direct people towards places that offer a functional capacity evaluation, which I think is the most appropriate way of determining disability.

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[Agast]

Anesthesia trained

I write for short term disability when it is appropriate. It’s not rocket science, if you think someone is enough pain that you should be sticking a needle into their spine repeatedly it stands to reason they are hurting enough to have difficulty maintaining job duties, especially physical ones. If their pain was not interfering with activity they would not be in your office.

 

[HouseofPain]

I write for short term disability when it is appropriate. It’s not rocket science, if you think someone is enough pain that you should be sticking a needle into their spine repeatedly it stands to reason they are hurting enough to have difficulty maintaining job duties, especially physical ones. If their pain was not interfering with activity they would not be in your office.

So anyone that’s referred to you

I write for short term disability when it is appropriate. It’s not rocket science, if you think someone is enough pain that you should be sticking a needle into their spine repeatedly it stands to reason they are hurting enough to have difficulty maintaining job duties, especially physical ones. If their pain was not interfering with activity they would not be in your office.

I write for short term disability when it is appropriate. It’s not rocket science, if you think someone is enough pain that you should be sticking a needle into their spine repeatedly it stands to reason they are hurting enough to have difficulty maintaining job duties, especially physical ones. If their pain was not interfering with activity they would not be in your office.

I guess it’s not rocket science if you’re criteria consists of wether or not you’re “sticking a needle in their back”. I’m assuming you like myself only do interventions on legit patients? I don’t think you would perform an intervention if it was not warranted. All I’m trying to say is pain is subjective and the majority of patients in my practice have legitimate pain complaints and are employed. How can you objectively draw a line and say this ones needs to be on disability but this one doesn’t? This guy’s disc is worse than this guy’s spondylosis? I don’t like to get involved with it because in my opinion introduces secondary gain into the picture. I’m happy to provide records but I’m not determining disability. That’s not what I do.

 

[Ducttape]

I don't think that makes that much of a difference, but to each his own.

I don't do short term disability (other than the day of a procedure) because my spiel to all patients is that we are here to help improve functionality as much as reduce pain. there is something inherently contradictory to tell someone that we will work on improving said functionality with "but heres a note to keep you out of work for an indefinite period of time" (because we all know that the majority of people will ask for an extension)

 

[Ducttape]

fwiw.... I have had a patient request time off of work so that he could go pick up his prescription medications and start them.

I told him "ill send it to the pharmacy downstairs then. you can wait in the waiting room up here and watch TV until its ready."

 

[dku_di4mds]

To claim benefits from disability income insurance policies (sponsored by an employer or purchased by an individual from an agent), the insured must be under the regular care of a physician appropriate for the disabling condition. Of course, not all medical conditions are necessarily disabling, and I agree that a physician should be compensated for documenting work restrictions, but I find it troubling that some physicians won't even consider helping their patients in this regard. I'm sure many of you have a disability policy either through an employer or purchased on your own. If you had to use it, would you want your physician(s) to assist you in supporting proof of disability to the insurance company?

 

[pastafan]

Charges for Copies of Medical Records May Violate HIPAA, Despite Compliance with State Law

A patient requests a copy of her medical record, and the hospital charges the per-page amount permitted under state law. Does this violate HIPAA? It may.

hipaahealthlaw.foxrothschild.com

 

[DOctorJay]

To claim benefits from disability income insurance policies (sponsored by an employer or purchased by an individual from an agent), the insured must be under the regular care of a physician appropriate for the disabling condition. Of course, not all medical conditions are necessarily disabling, and I agree that a physician should be compensated for documenting work restrictions, but I find it troubling that some physicians won't even consider helping their patients in this regard. I'm sure many of you have a disability policy either through an employer or purchased on your own. If you had to use it, would you want your physician(s) to assist you in supporting proof of disability to the insurance company?

I would personally seek out a physician who was expert in these matters to ensure things were done properly and gave me the best chance of receiving the benefits I paid for.


Sent from my iPhone using SDN

 

[deleted993114]

It also helps that virtually nobody is disabled. Just say no.

Ironically, I qualify for both SS disability and disability via my private policy. I calculated what my impairment rating would be (5th edition), and it is 26%, which is pretty high.

Of course, the guidelines for impairment are different than SS disability or private policies. That being said, my PCP encouraged me to go the disability route and I refused.

Working is a matter of pride and I personally would never take disability unless it was impossible to work. So when patients ask me, I tell them my impairment rating is much higher, but I drag my ass out of bed and go to work.

If you don’t work, it’s a bad example to set for your family- tough it out and go to work.

 

[lobelsteve]

Ironically, I qualify for both SS disability and disability via my private policy. I calculated what my impairment rating would be (5th edition), and it is 26%, which is pretty high.

Of course, the guidelines for impairment are different than SS disability or private policies. That being said, my PCP encouraged me to go the disability route and I refused.

Working is a matter of pride and I personally would never take disability unless it was impossible to work. So when patients ask me, I tell them my impairment rating is much higher, but I drag my ass out of bed and go to work.

If you don’t work, it’s a bad example to set for your family- tough it out and go to work.

And that 26% does not include any of your mental health?

 

[drusso]

Ironically, I qualify for both SS disability and disability via my private policy. I calculated what my impairment rating would be (5th edition), and it is 26%, which is pretty high.

Of course, the guidelines for impairment are different than SS disability or private policies. That being said, my PCP encouraged me to go the disability route and I refused.

Working is a matter of pride and I personally would never take disability unless it was impossible to work. So when patients ask me, I tell them my impairment rating is much higher, but I drag my ass out of bed and go to work.

If you don’t work, it’s a bad example to set for your family- tough it out and go to work.

Those kind of values are fading in our society as we move more toward a collectivist welfare state model of government—especially in health care. Mind how you vote 2020.

 

[deleted993114]

And that 26% does not include any of your mental health?

That is a great point (watching the Chiefs game, I got a good laugh!). My wife would certainly agree with you.

Ironically, you cannot claim ANY percentage points for mental health. They stopped that after the 3rd edition of the guidelines for impairment. What you note is not ratable impairments (mental health is one) that can contribute to weighing in favor of granting the patient an impairment, but does not affect the number. It can determine work restrictions as well(but is not ratable, so that happens in a legal arena). So you grade the degree of disability within the three componants of, for example, an effective disorder.

When you get cancer, they put you on anti-depressants, even if you aren't depressed. And you get no points whatsoever for being on certain meds-so I g I don't get any points whatsoever for being a nut- I kind of feel ripped off by that, but the impairment guidelines are pretty clear about it. The 6th edition has really cleared up a lot of "gray areas" in impairment, with fairly precise ratings and no wiggle room for ROM deficits.

 

[deleted993114]

Those kind of values are fading in our society as we move more toward a collectivist welfare state model of government—especially in health care. Mind how you vote 2020.

I am pretty sure you (and most others here) would do the same thing. I know there are patients who need and certainly deserve disability, but when faced with the prospect of being "disabled" as a physician, accepting that designation would be a "scarlet letter". Besides, you are still going to have the same problems whether you are at work, or at home, so you might as well go to work.

I was one of Trump's first supporters when he was one of 18 (so I guess I will vote for him again and probably give him more money). I like him, as he is not a Washington insider; I am actually surprised that dems hate him, as he shares many views with moderate dems (they will never admit that). I would actually support a weird medical policy- one that LOWERED, not increased, the medicare age. As the 50s are "the kill zone" for many disease processes, I think they should lower the medicare age to 50 (for those who want it), and enroll all kids in medicare until age 18, so that more families are not wiped out by big medical expenses. 18-50- you are on your own.

I personally will never go on medicare, as I need top of the line medical care, and I know that medicare puts you to the "end of the line" at some institutions at which I may have to seek services. Thus, I need to keep working forever in order to have top notch health insurance. Even with a very good blue cross policy, I pay over $1K every month for meds alone (even with insurance coverage). That is peanuts for physicians, but would be a huge dent in the budget for most Americans.

 

[Ducttape]

they should lower the medicare age to 50 (for those who want it)

you should look at Buttigieg….

 

[deleted993114]

they should lower the medicare age to 50 (for those who want it)

you should look at Buttigieg….

I'm afraid the other policy aspects that democrats support make it impossible for me to support them. if only the dems had remained the party of Truman, that would be different.

 

[lonelobo]

I'm afraid the other policy aspects that democrats support make it impossible for me to support them. if only the dems had remained the party of Truman, that would be different.

But instead you vote for the Party of Putin,,,interesting

 

[SSdoc33]

I'm afraid the other policy aspects that democrats support make it impossible for me to support them. if only the dems had remained the party of Truman, that would be different.

remained? that was 70 years ago. were you attending political rallies as a kindergartener?

as an ethical, hard-working guy, i can see how you can support the GOP. i cannot see how you can support DJT. DJT is not what the GOP typically stands for and is certainly not Trumanesque.

also, not all democrats are on the bernie, lizzie, progressive bandwagon

 

[Ducttape]

I'm afraid the other policy aspects that democrats support make it impossible for me to support them. if only the dems had remained the party of Truman, that would be different.

you should review a lot of the platforms that Buttigieg - and, to some extent, biden - specifically have espoused. they are much more centrist than Obama. most are where the GOP would be if they were not hellbent on supporting trump at all costs.

 

[VA Hopeful Dr]

you should review a lot of the platforms that Buttigieg - and, to some extent, biden - specifically have espoused. they are much more centrist than Obama. most are where the GOP would be if they were not hellbent on supporting trump at all costs.

You mean like doing away with the Electoral College?

 

[Ducttape]

I don't necessarily agree with that, but isn't our democracy based on the fact that all votes count?

 

[deleted993114]

But instead you vote for the Party of Putin,,,interesting

"Party of Putin"?

One could say a number of similar things about the dem party, but it would be equally ridiculous.

Keep in mind that political beliefs rarely, if ever, change and that such beliefs are steeped in lifelong personal experiences and emotion. Just because someone supports one party of another does not make them an idiot, or irrational. Everyone has their own reasons for their political beliefs and have a right to support those who reflect their views.

 

[deleted993114]

I don't necessarily agree with that, but isn't our democracy based on the fact that all votes count?

No- it is not. We are a republic, not a democracy. One should understand that initially, only property owners were allowed to vote.

The purpose of the electoral college was to assure smaller states that the more populous states (at that time Virginia) would not elect the president every year and thus have a POTUS who would ignore the sentiments of smaller states. Even with the electoral college, note where most of our early presidents came from.

If there was no electoral college, ten urban areas would select the president every four years. There would be little reason for about 30 states to be a part of the Union, as their regional interests and needs would be ignored at the executive level.

If one seeks to destroy the Union, eliminating the electoral college would be a good start.

 

[VA Hopeful Dr]

I don't necessarily agree with that, but isn't our democracy based on the fact that all votes count?

There is no way to structure things without someone feeling like their vote doesn't count. If you go to a straight popular vote, its going to be the people who live in more rural places.

I say feeling because no matter how we do it votes do count.

 

[Ronin1]

I don't necessarily agree with that, but isn't our democracy based on the fact that all votes count?

We don’t live in a democracy, it’s a republic.

 

[SSdoc33]

No- it is not. We are a republic, not a democracy. One should understand that initially, only property owners were allowed to vote.

The purpose of the electoral college was to assure smaller states that the more populous states (at that time Virginia) would not elect the president every year and thus have a POTUS who would ignore the sentiments of smaller states. Even with the electoral college, note where most of our early presidents came from.

If there was no electoral college, ten urban areas would select the president every four years. There would be little reason for about 30 states to be a part of the Union, as their regional interests and needs would be ignored at the executive level.

If one seeks to destroy the Union, eliminating the electoral college would be a good start.

you mean those 30 states with 1/4 of the population? those 30 states who have 60 senators, yet have only a fraction of the population?

arbitrary land borders based on latitude coordinates without taking into account population is ludicrous -- both in the senate AND the electoral college. the house of reps is not an equal counterbalance to the structural deficiencies in the senate and electoral college. what we end up with is a government that is not what the majority of americans want.

if those 10 urban areas are where people live, then those 10 urban areas should get to choose the president.

 

[Ducttape]

I fully undetstand the electoral college, which is why I prefaced my statement.
you are correct.

but, my point was that the electoral college does downgrade the importance and effectiveness of the individual voter who lives in the urban area.

 

[VA Hopeful Dr]

I fully undetstand the electoral college, which is why I prefaced my statement.
you are correct.

but, my point was that the electoral college does downgrade the importance and effectiveness of the individual voter who lives in the urban area.

A fairly easy fix would be to increase the number of US Reps until the population/rep is roughly the same across the whole country. There would always be some inequality due to the Senate seats, but it would be lessened.

 

[lonelobo]

How about stop Gerrymandering and Voter Suppression....The electoral college argument would be mute by addressing the later

 

[VA Hopeful Dr]

How about stop Gerrymandering and Voter Suppression....The electoral college argument would be mute by addressing the later

I agree with stopping both of those, but how does the address the electoral college argument?

 

[lonelobo]

I agree with stopping both of those, but how does the address the electoral college argument?

Because if there was not voter suppression The DEMS would have won both the popular vote and electoral college

 

[VA Hopeful Dr]

Because if there was not voter suppression The DEMS would have won both the popular vote and electoral college

Ah, so the electoral college is only a problem if the Democrats don't win the election.

I appreciate your honesty.

 

[lonelobo]

Ah, so the electoral college is only a problem if the Democrats don't win the election.

I appreciate your honesty.

You don't believe the Republicans would have concerns if situation were reversed?

 

[VA Hopeful Dr]

You don't believe the Republicans would have concerns if situation were reversed?

Decent chance, but it would be epic level hypocrisy given both 2000 and 2016 so I'm not sure it would get as much traction.

 

[Gauss]

Do the insurance companies not have their own physicians that review claims? Im more than happy to give them a copy of records but don’t see the need for me to determine that. It goes back to the slippery slope argument. I see patients with legitimate complaints everyday that work. Do they all qualify for FMLA/disability because the have pain and their job is physical?

FMLA and disability are very different things
ignorance is not benefiting your patients and increases your liability

 

[Ferrismonk]

I was one of Trump's first supporters when he was one of 18 (so I guess I will vote for him again and probably give him more money). I like him, as he is not a Washington insider; I am actually surprised that dems hate him, as he shares many views with moderate dems (they will never admit that). I would actually support a weird medical policy- one that LOWERED, not increased, the medicare age. As the 50s are "the kill zone" for many disease processes, I think they should lower the medicare age to 50 (for those who want it), and enroll all kids in medicare until age 18, so that more families are not wiped out by big medical expenses. 18-50- you are on your own.

they should lower the medicare age to 50 (for those who want it)

you should look at Buttigieg….

FWIW, the age of 65 was chosen for Medicare/SS because that was the life expectantly. The understanding is that you were responsible for appropriate planning for your life, but if you lived past when you were expected to die (and by extension what you should have planned for) or became disabled early, the government insurance would kick in and support you. It was never meant to be a retirement plan. With this reasoning, the age these kick in should be 79.

 

[Gauss]

FWIW, the age of 65 was chosen for Medicare/SS because that was the life expectantly. The understanding is that you were responsible for appropriate planning for your life, but if you lived past when you were expected to die (and by extension what you should have planned for) or became disabled early, the government insurance would kick in and support you. It was never meant to be a retirement plan. With this reasoning, the age these kick in should be 79.

Incorrect, life expectancy may have had some bearing on SS but not Medicare.
SS: Social Security History
Whereas Medicare: "only approximately 60% of people over the age of 65 had health insurance, with coverage often unavailable or unaffordable to many others, as older adults paid more than three times as much for health insurance as younger people." Medicare (United States) - Wikipedia

 

[Ducttape]

Agreed. The Germans decided in using that age for their version of SS when they set up their program in the 1880s. FDR used age 65 because about half of employee pension plans ended at age 65 - along with Federal Railroad Retirement Program, and they thought sustainability with age 65.

medicare came later. 65 was used because it was modeled after SS, which was a popular program at the time, and because 57% of Americans age 65+ had no health insurance...

FWIW, medicare for all was a proposed reform plan back in the 1950s,..

 

[lobelsteve]

 

[SSdoc33]

france is considering rioting b/c macron wants to increase the pension age from 62 to 64

 

[Ligament]

if those 10 urban areas are where people live, then those 10 urban areas should get to choose the president.

No. Read up on how the US government was designed. Does not work that way, and that would be a disaster to the union of states.
Those 10 urban areas represent only SIX states. We are the United STATES of America. Each state needs to be represented.

 

[SSdoc33]

No. Read up on how the US government was designed. Does not work that way, and that would be a disaster to the union of states.
Those 10 urban areas represent only SIX states. We are the United STATES of America. Each state needs to be represented.

wyoming should not have equal senate weight as california. the country is much different than it was in 1787

 

[VA Hopeful Dr]

wyoming should not have equal senate weight as california. the country is much different than it was in 1787

Wrong, that's the exact purpose of the Senate. The House is where California gets its weighted say.

And the country is different that's true, but the ideas behind why our country is set up the way it is haven't changed.

 

[SSdoc33]

Wrong, that's the exact purpose of the Senate. The House is where California gets its weighted say.

And the country is different that's true, but the ideas behind why our country is set up the way it is haven't changed.

thanks for the civics lesson.

as currently constituted, a farmer in wyoming has more say is the way government works than a burger king employee in LA.

my point is that the set-up of our republic is outdated and essentially non-functional. washington is about is nimble as the titanic. the parliamnetary systems in europe work WAY better.

 

[lonelobo]

Wrong, that's the exact purpose of the Senate. The House is where California gets its weighted say.

And the country is different that's true, but the ideas behind why our country is set up the way it is haven't changed.

OF course we know the SENATE wields quite a bit more power than the house

 

[Ligament]

wyoming should not have equal senate weight as california. the country is much different than it was in 1787

Of course Hawaii should have the same weight as California. It is a state in the republic and needs to be represented.

Following your logic, only a few states (around 6-7) would hold ALL the power in this union of states.

 

[lonelobo]

Of course Hawaii should have the same weight as California. It is a state in the republic and needs to be represented.

Following your logic, only a few states would hold ALL the power in this union of states.

Then again every person doesn't have equal representation

 

[VA Hopeful Dr]

thanks for the civics lesson.

as currently constituted, a farmer in wyoming has more say is the way government works than a burger king employee in LA.

my point is that the set-up of our republic is outdated and essentially non-functional. washington is about is nimble as the titanic. the parliamnetary systems in europe work WAY better.

That's not even slightly true.

It can be functional when it needs to be, the only times that I can recall it not being functional are a result of the severe partisanship we find ourselves in. Look at how quickly things happen when its important: Obama got his stimulus plan passed after being in office less than a month, Bush created a whole new governmental department 2 months after 9/11, Bush's response to the Great Recession got passed in just under 2 weeks. Heck, even the extremely divisive ACA and Trump tax cuts eventually got passed.

Now I am going to need you to explain how its outdated.

 

[VA Hopeful Dr]

Then again every person doesn't have equal representation

And that's always going to be true barring a true Greek style democracy which thankfully very few people actually want.

 

[soccrwz]

Funny little story often repeated:

The story of the "senatorial saucer" is based on a supposed breakfast meeting between Thomas Jefferson and George Washington. In 1872, Moncure Daniel Conway told the story as follows:

There is a tradition that Jefferson coming home from France, called Washington to account at the breakfast-table for having agreed to a second, and, as Jefferson thought, unnecessary legislative Chamber.
"Why," asked Washington, "did you just now pour that coffee into your saucer, before drinking?"
"To cool it," answered Jefferson, "my throat is not made of brass."
"Even so," rejoined Washington, "we pour our legislation into the senatorial saucer to cool it."1

.....One possible indication that it is apocryphal is the fact that, to all appearances, Jefferson was not against the idea of a bicameral legislature. He wrote to the Marquis de Lafayette in 1789, "... for good legislation two houses are necessary...."3