Saturday, July 20, 2013


The other day an IC patient that used to be Facebook "friends" with me posted about filing for SSDI and how "Obamacare" was making it more complicated and how she "hated" the Affordable Care Act (the correct name for the legislation). Her claim was that due to the Affordable Care Act, it is now MANDATORY to send all medical records to your regular (primary care) doctor and not just have the treating specialist complete the paperwork and submit the appropriate medical records.  She said her doctor (actually said 3 told her this) is saying that the primary care is the one that "decides if I am unable to work. My doctor said that Obamacare has tied the hands of specialists, leaving it up to primary care doctors to make decisions about my disease."

I tried to explain that this is NOT the case. Unfortunately, I can't post this to her anymore as apparently my disagreement with her warranted an "unfriending". My goal, although I do support the legislation, is always to try to help people navigate filing for SSDI and I was not trying to discuss politics. I do support the legislation and it is a mystery to me how anyone suffering from chronic, incurable illness that is filing for SSDI and is facing a real possibility of losing insurance coverage, having claims denied and more, could oppose this. And although she offered no substantive arguments, she made it clear she "hated" it. That's fine. 

But the reality of the point I want to make to everyone who is or might be filing for SSDI is that the Affordable Care Act and SSDI are NOT, repeat NOT connected in ANY way whatsoever. If your doctor is telling you this, they are misleading you because they have their own reasons for not liking the legislation and/or don't want to take the time to file the paperwork themselves and want to push it off on another doctor.

I take this very seriously and wanted to be sure I had my facts straight, so I went straight to my own Disability Representative who helped me file and appeal my claim. Here are is comments verbatim:

"I am unaware of any provision of the Affordable Health Care Act that impacts the filing or imposes processes not currently in place. Although I have not researched thoroughly, the Affordable Health Care Act impacts only health care access. It does not address SSDI disability claims. It does impact disabled individuals ability to obtain health insurance by eliminating pre-existing conditions and providing some financial assistance to pay for health insurance based on income and/or lack thereof. 

Having stated the above, what you describe below would appear to me to be routine whether or not there was/is an Affordable Health Care Act:
  1. An individual’s primary care physician would normally make referrals to a specialist.
  2. The specialist would normally provide a report of findings or lack thereof to the primary physician
  3. Based on those findings the primary physician forms a medical judgment that enhances, modifies, etc., his medical opinion based on the medical evidence
  4. The primary physician is also reliant upon the specialists for their medical expertise and for which he/she does not have the expertise

So, the primary physician’s medical opinion is of import but is tied to the medical opinion of the specialist in determining the total disability of an individual. I would think that if the specialist said you were disabled and the primary physician does not, an unusual situation, the SSDI claim for disability becomes very problematic."

My intention is to always help people navigate their way through the Disability process. I am not an attorney and don't claim to be. But I have been through it, keep current, understand the process and do my research in an attempt to provide assistance to others feeling overwhelmed by the process.

If anyone is going to be filing for SSDI, hopefully this information will be helpful to you.

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