Disability Claims, Medical Record Release, and the Law Here are some thoughts on disability claims, the onus on providers to release the medical records for review, and the related legal aspects.
Medical records are indispensable to prove disability and obtain the due benefits from the Social Security Administration (SSA) and the Department of Veterans Affairs (VA). This recent news highlighted the plight of a 59-year old Cohoes woman, Candas Woodard, who desperately needs her medical records to claim increased disability payments from the Department of Veterans Affairs. Apart from disabilities connected to military service, she has other disabilities as well, and lives on disability payments she receives from the VA and SSA. The issue here is that Ms. Woodard’s doctor is withholding her records on the grounds that she has not paid her bill.
Review of Pertinent Medical Records Vital to Prove Disability Candace Woodard had a botched C-section in 1979 during her three-year tenure at Maxwell Air Force Base, Alabama, for which she is hoping to obtain increased disability insurance from the VA. She has been arguing with the VA for an increase for ten long years, and it is only last week that the VA acknowledged that her condition warrants a higher rating on the VA benefits scale. However, the problem now is that she has to produce the relevant medical records for review so that the concerned authorities can proceed with the case and possibly take a decision in her favor. For this she needs the above mentioned doctor who performed a laparoscopy on her to release her healthcare records. She had gone outside the VA system and the free medical care it provides to obtain the laparoscopy test because her VA doctor would not do this test. Now she requires her laparoscopy records as well as a statement from the doctor.
The Legal Angle Let us consider the legal angle here. The HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule gives patients, with a few exceptions, the right to inspect, review and receive a copy of their medical records and billing records held
by covered entities such as health plans and healthcare providers. Healthcare providers cannot deny patients a copy of their records because they have an unpaid bill. A patient who has not been given access to his/her medical records can file a HIPAA Privacy Rule Complaint with the U.S. Department of Health and Human Services (HHS) Office of Civil Rights, at http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html. New York State law requires providers to give patients an opportunity to see their healthcare records within 10 days of placing a request. Providers and facilities can charge the patient for photocopying costs, but cannot deny access if the patient cannot pay for copies. The law also allows the provider to withhold certain items such as the provider’s own observations, confidential information that was entrusted, substance abuse records and mental health records. Attorneys with experience and expertise in the field would advise providers to release medical records to patients who request them. Failure to do so may land them in legal hassles, apart from having to incur loss of revenue from unpaid bills.