When Brenay Torres, a mother of two in West Virginia, found a lump in her breast, she was sent for an ultrasound after her mammogram was inconclusive. But when she tried to set up the ultrasound appointment, she ran into an unexpected roadblock.
“That is when the nightmare began,” Torres said. She was sent to a different medical office to get the ultrasound done. But before she could be seen, they required the images from her mammogram — and the fee to get a copy of those records was $175.
Torres said she tried to negotiate a more reasonable fee, but the mammogram facility would not budge.
“The fee was too high for me to pay — and I could not get the ultrasound done. Every day I was extremely anxious that I could have cancer and it was spreading inside my body,” Torres said.
Because there are a limited number of providers in her town, it took Torres a while to find another imaging center that didn’t require the previous records, and she had to wait over three months until they had an opening.
“The whole situation was extremely stressful and it started because of the exploitative records fee — why can’t I have a picture of my own body without paying a high fee? These fees can limit a patient’s access to their medical information and the ability to coordinate their care,” said Torres.
Torres’s experience is not unusual.
While people are legally entitled to their medical records under federal law, many encounter burdensome fees when they request electronic or hard copies of their records.
Online patient portals have increased access to medical information, but patients may still need hard copies of their records when switching to a new doctor, dentist, imaging center or when they are referred to a specialist. Patients may also need hard copies for their own personal record-keeping.
“You can’t rely on the portal for everything, especially with imaging,” Torres said.
Under the Health Insurance Portability and Accountability Act (HIPAA), providers may charge a “reasonable, cost-based fee,” which includes labor for copying the record (paper or electronic) and supplies (paper, CD, postage). But it may not include costs related to verifying, searching for and retrieving medical records. Requested records are also supposed to be sent within a timely manner, generally 30 calendar days.
Read: Health Insurance 101 for Women: What You’re Entitled to as a Woman >>
Medical records fees vary by state
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Concerns about increasing healthcare costs — including unexpected fees — are growing. But even with HIPAA guidelines on medical records fees, the cost can still vary significantly depending on the facility, provider and the state they practice in.
Several states regulate what providers are allowed to charge, and some permit patients to receive one free copy of their records. Other states, such as Idaho, Kansas and Alaska, do not have laws in place that regulate records fees. Some states charge a flat fee, while others charge anywhere from 50 cents to $2 per page.
In some instances, even if a state permits certain fees, it may not be in compliance with the HIPAA Right of Access Provisions. Ultimately, if there’s a conflict between state laws and HIPAA on these fees, whichever law is more favorable to patients and provides a more affordable option generally takes precedent.
This nationwide patchwork of different rules for different states can lead to limited oversight on provider compliance and fees, which can result in an expensive and challenging process for patients.
Patients may be unaware of the HIPAA fee regulations and may not know they have the right to challenge providers who charge excessive or prohibited fees.
Caitlin Donovan, senior director of the Patient Advocate Foundation, said that it can be an administrative burden on providers to process records requests, but accessibility for patients should still be the priority and access to obtaining records should not depend on a patient’s ability to pay.
“Patients are entitled to their medical records, in the format that they request, but at a certain point these records are no longer accessible if it is not affordable,” Donovan said.
What can you do if you if you’re encountering high medical records fees
If patients encounter medical records fees that pose a hardship, Donovan recommended checking to see if the fee is allowed in their state and speaking to the billing office about their concerns. Patients also have the right to report exorbitant fees to their state’s inspector general office and their state’s consumer protection office.
If a provider is not adhering to state laws or HIPAA regulations, patients can file a HIPAA complaint with the Office of Civil Rights (OCR). If a patient has insurance, they can also file a complaint with their insurance company.
Donovan added that practice protocols can vary by provider, but suggested asking if the provider/facility can request the records directly from the provider who has them — sometimes provider to provider requests do not result in a fee.
Vulnerable patients can be impacted more
Marginalized communities and patients with complicated medical histories who already experience health disparities can be particularly impacted by these fees.
“Fees can be another barrier for marginalized communities,” said Faith Ohuoba, M.D., an OB-GYN in Texas and clinical associate professor at the University of Houston. Ohuoba said that while there can be an increase in administrative work for the office staff to process different record requests, providers still need to be conscious of the impact these fees have on patients.
Women, who already spend more on healthcare compared to men, can also end up paying more in records fees. According to Ohuoba, women frequently have preventive screenings (mammogram and Pap tests) and these tests may be done at different facilities, which means they could potentially end up paying even more in fees to get their records from each medical office.
For patients who are not able to pay for an imaging CD, Ohuoba said to bring a copy of the imaging report to a new provider since these can typically be printed from the patient portal.
Read: A Guide to Medical Imaging for Women >>
Transparency is key
Ohuoba said that transparency is critical and it’s important for providers to disclose any fees that they charge up front. If you get an excessive records fee, Ohuoba said to request an itemized bill and ask for more specific information on what you’re being charged for. She noted that some facilities may say they have a flat fee for every record request, but asking for this specific information can still be an important part of increasing transparency in billing.
“Providers need to be empathetic to how fees may impact patients, offer different payment options and work with patients to resolve the issue,” Ohuoba said.
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