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Bruce Page
06-21-2014, 12:49 PM
My wife received a letter from one of her doctors that he is closing his doors and retiring at the end of June. If she wants a copy of her medical records she has to pay a $35 fee and 25 per page.

This seems wrong to me. Is this normal practice?

Art Mann
06-21-2014, 1:00 PM
I don't know whether it is common practice or not but it seems wrong to me too.

Matt Meiser
06-21-2014, 1:30 PM
I'd contact whatever state authority that has jurisdiction over that Monday morning and ask. But I bet its allowed if they put it in writing.

Rick Gibson
06-21-2014, 2:09 PM
I know when we moved 11 years ago there was a $25 fee for a copy of our medical records to be sent to our new doctor. the 25 cents per page may be excessive but I would expect to pay for them seeing as the Dr. has to pay someone to make the copy and pay for the paper, toner etc. The originals likely go to some govt. file to be used against you at some future date.

Saw my Dr. Wed. for a prescription renewal and had to give a urine sample. Dr. said the govt. wants it so they can be sure I am actually taking my meds and not selling them on the street.

Raymond Fries
06-21-2014, 3:48 PM
I believe that they can charge and you should get them before the doctor closes his doors. You might need them someday and it might be very difficult to get them then. We spend hundreds collecting everything we needed when my wife applied for disability. His fees are way less some of them that we had to pay.

Yes it is your personal data but they used their resources and paid their employees to record everything they have. They will also have to use their resources to copy them for you.

John Coloccia
06-21-2014, 3:55 PM
My wife received a letter from one of her doctors that he is closing his doors and retiring at the end of June. If she wants a copy of her medical records she has to pay a $35 fee and 25 per page.

This seems wrong to me. Is this normal practice?

It's pretty normal, though it goes state by state. I think it's also pretty common that if another doctor requests the records to provide you care, they do NOT charge.

So have her new doctor make the request, and that's that.

But I don't know this for a fact...I'm going off of vague memory.

Bruce Page
06-21-2014, 4:35 PM
It just doesn't feel very ethical on the doctor's part. We and our insurance already paid for this documentation when it was generated.
We'll pay the fee, I just won't be happy about it. :mad:

Raymond Fries
06-21-2014, 5:27 PM
I agree with the ethics and your point of view. I think they take it because they can.

John Huds0n
06-21-2014, 6:21 PM
Why would there be a 'copy' fee. He is going out of business, your probably saving him from having to have the records shredded. You should get the originals

Eric DeSilva
06-21-2014, 7:01 PM
I guess I'm the devil's advocate. Just because the records are about you doesn't make them yours--you and your insurance company paid for treatment, not the creation of records. The records are a byproduct that is useful to the doctor as he diagnoses and treats other maladies you later have. And the fact that he is closing his doors doesn't mean that he can get rid of the records--there are a lot of record retention requirements, so you aren't saving him any money by relieving him of the requirement to shred them. If you were a small business and kept records of your customer's purchases to better market to them and to better address their needs in the future, would you consider those records the "property" of your customer?

Charles Wiggins
06-21-2014, 7:40 PM
My wife received a letter from one of her doctors that he is closing his doors and retiring at the end of June. If she wants a copy of her medical records she has to pay a $35 fee and 25 per page.

This seems wrong to me. Is this normal practice?

From: New Mexico Medical Board Website (http://www.nmmb.state.nm.us/):


Q. Medical Records. Who “owns” my medical records? How do I get them?

A. Medical records are in the “custody” of the Physician or the Hospital or the Clinic providing service. A patient does not “own” the record, either. Medical records are confidential material, and are protected under strict laws, including the recent HIPAA Law (Health Insurance Portability and Accountability Act). A patient may request a copy of the record and must sign a release, either to have a copy of that record, or to have that copy sent to another Physician or facility. Special releases may be required for psychotherapy notes and may be withheld from the patient. Drug and alcohol, and HIV/AIDS records also require special releases.

According to the NMMB Rule 16.10.17.8, medical records may not be withheld because an account is overdue or a bill for treatment or other services is owed. A reasonable cost-based charge may be made for the cost of duplicating and mailing medical records. A reasonable charge is not more than $30.00 for the first 15 pages, and $0.25 per page thereafter.

http://www.nmmb.state.nm.us/pdffiles/ConsumerFAQ.pdf

Here's a link to the referenced rule to confirm the allowed costs: http://www.nmmb.state.nm.us/pdffiles/Rules/NMAC16.10.17_MedicalRecords.pdf

Good luck!

Brett Luna
06-21-2014, 8:09 PM
The latter part of military career was in health care administration, which included the filing, maintenance, and copying of medical records. I haven't worked in the field as a civilian but here's my take on it from that perspective. The records we created for patients are Government property, even when they relate to civilian dependents of military personnel. Yes, mine contain personal, sensitive medical information about me but they don't belong to me. Upon retirement, I was allowed one free copy for myself and one free copy for submission to the VA if I wanted it. Additional copies were available at a cost per page. The originals remain Government property and are still on file in my local military hospital, since I am a retiree. If I had been simply separated, they would now be on file in the National Personnel Records Center.

I view civilian medical records much the same way. I pay healthcare professionals for a service. The records they create are primarily for their use in delivering that service. They have to keep records of what they do, if for no other reason than to defend against litigation. If I were in their place, I certainly wouldn't give up my internal records at least until my exposure to liability had expired with certainty. I wouldn't feel obligated to provide free copies unless it were required by law.

Brian Elfert
06-21-2014, 8:53 PM
I assume this doctor had not switched to electronic records. I wonder how this all works with electronic medical records, especially if both doctors use the same software? Can records be transferred electronically to make it easy and cheap? Providers using EPIC, on of the biggest medical records software providers, can already share with many other providers who also use EPIC.

Bruce Page
06-21-2014, 9:39 PM
Thank you Charles. We'll take this info with us on Monday.

William Payer
06-21-2014, 10:37 PM
Went through this last year when I wanted a copy of my records ( getting a second opinion ). According to Blue Cross the doctor OWNS the records, despite the fact that the insurance company and patient have paid for the tests to actually accrue the data. Legally the doc owns them but as a patient you are allowed to get copies of your records and fees charged are considered normal and applicable.

Joel Goodman
06-21-2014, 10:46 PM
+1 on having your new doc request the records. It feels like double dipping to charge for them. But to me the whole idea that you don't get a copy of your medical work at the time you have it done is out of date and paternalistic. People move around and it would be better to have the stuff for future needs. When I had an MRI for a shoulder issue I made sure I got a copy of the disc and the report.

Frank Drew
06-22-2014, 1:45 PM
Can records be transferred electronically to make it easy and cheap?

Yes, and when medical record keeping becomes the norm patients will, or should, have access to their own records and can download and print, or electronically file, what they need.

Jason Roehl
06-22-2014, 5:05 PM
I guess I'm the devil's advocate. Just because the records are about you doesn't make them yours--you and your insurance company paid for treatment, not the creation of records. The records are a byproduct that is useful to the doctor as he diagnoses and treats other maladies you later have. And the fact that he is closing his doors doesn't mean that he can get rid of the records--there are a lot of record retention requirements, so you aren't saving him any money by relieving him of the requirement to shred them. If you were a small business and kept records of your customer's purchases to better market to them and to better address their needs in the future, would you consider those records the "property" of your customer?

I think just because it's become common practice doesn't mean it's right. I'd say that the 4th Amendment applies, as this is all part of being secure in one's person. As for the actual record-keeping, whatever the reason, it's out of hand. The last few times I've been in a hospital or ER (with someone else), anytime a nurse does anything, 3/4 of the time in the room is at a computer, drilling down through a complex menu system, even when just taking some vital signs. I think it would be a good idea to get a full copy of everything done at the time of service, just in case there is litigation in the future. Don't need their computers crashing inexplicably...

Al Launier
06-22-2014, 5:42 PM
It would seem to me that if a practitioner was closing his doors a reasonable fee would be appropriate for your medical records to be transferred to your new doctor. HOWEVER, I would certainly hope these would be the original records & not "copies". Further, any records not wanted, if that's realistic, should be destroyed with your review & approval. Only your current doctor should have your medical records. He/she can decide if necessary to convey pertinent medical information about you to other medical professionals if necessary & with your approval.

Len Mullin
06-22-2014, 10:57 PM
I needed a copy of my medical records for insurance reasons, I asked for a complete copy at the Dr's office and got them for free. It took a couple of days to get them, and I expected to pay for them, but, when I went to pick them up the receptionist just handed them to me and wished me good luck. When I asked about paying for them, and she stated that she was told not to charge anything.
Len

Stephen Tashiro
06-23-2014, 2:27 AM
From recent experiences in getting medical records for some friends, 25 cents a page is typical charge for paper copies of records from hospitals and nursing homes. Perhaps by coincidence, the local Office Max charges about the same to copy a paper page to an electronic format.

The outpatient lab at the local Memorial Medical Center will give a the patient 1 free paper copy of results of things like MRIs. They will even give the patient one free CD of the scan.

It's a rather typical experience to give a doctors office detailed medical records and give detailed information to the technicians who do preliminary interviews and then find that the physician who arrives at the examination room doesn't know this information. The physician only knows what a quick glance at "the chart" shows. If you request the "complete record" from a hospital, you will get a lot of paper that nobody will ever use. It's costs less to pick a more specific option.

Phil Thien
06-23-2014, 9:33 AM
I wonder how useful medical records are to a new physician.

I suppose it depends on the patient and any chronic conditions or long-term medications.

John Pratt
06-23-2014, 10:22 AM
The latter part of military career was in health care administration, which included the filing, maintenance, and copying of medical records. I haven't worked in the field as a civilian but here's my take on it from that perspective. The records we created for patients are Government property, even when they relate to civilian dependents of military personnel. Yes, mine contain personal, sensitive medical information about me but they don't belong to me.

I remember early in my career that a soldier would just carry their medical records from appointment to appointment, and from duty station to duty station. Late in my career I was not even allowed to see my medical records. The records keeping facility always threw HIPAA out there and that they wanted to ensure the records were not lost in transit. Ironically, the records department at that installation had a reputation for losing records on a regular basis.


I wonder how useful medical records are to a new physician.

I suppose it depends on the patient and any chronic conditions or long-term medications.

In the military your medical records mean everything when it come to the VA. If you do not have an ailment, diagnosis, MRI, X-ray, etc in your records, it did not happen. The onus of proof is on the soldier to provide the evidence it is service related when filing for a disability. I witnessed a soldier go round and round with the VA trying to prove that the leg he lost was due to his service in Iraq becuase his records were lost. I know I have two copies of my records just for safe keeping.

Andrew Pitonyak
06-23-2014, 11:07 AM
This is not uncommon. It is also not uncommon that they will not give you a copy directly, but may send a copy to another physician. If they will not give you a copy directly, they make a sudo copy. The difference is that of full photo type copy of everything unfiltered compared to an edited version that may have some of their notes removed.

mike holden
06-23-2014, 11:35 AM
FWIW, I am being treated at the University of Michigan Hospital. There is a website, powered by epic, that allows me to communicate with my doctor(s) at UofM and see the test results almost as quick as they see them.
The interesting and pertinent part of this is that I can download a copy of my total record in what is called a "LUCY" file to take to my personal physician.
I now carry a thumb drive with all my medical records in my pocket.
The only problem is how to notify any emergency people of this data if I am incapacitated. I am thinking of a medic alert bracelet directing them to the thumb drive.
Hopefully, this "LUCY" data idea will catch on.
Mike

Eric DeSilva
06-23-2014, 1:41 PM
The 4th Amendment applies to being free from unreasonable search and seizures by government action--I don't think I see any government action here, nor do I understand the relationship to search and seizure.

Think about this: If I commission a woodworker to build me a custom set of cabinets, does that mean that I have the right to demand that he turns over all his paperwork and plans when he's done? The answers is "of course not." I'm not sure I see it any differently in the GP context. As for "he should do it for free," I see another side there too. If he's retiring, figure he has 50 years worth of medical records on thousands of patients. If he says "sure, just ask for them and I'll give them to you for free," he's going to spend the next year sorting through things and it will probably cost him tens of thousands of dollars. On the other hand, if he raises the bar a bit so only the people that are really interested take him up on it, he can probably close his doors faster. Just sayin'.

Brian Elfert
06-23-2014, 1:46 PM
It is unlikely the doctor would deal with medical record disposal personally. They probably had at least one staff person working with them who would likely deal with this. I bet there are companies the doctor could hire to deal with parsing out the records. I'm sure the company could do okay at $35 per file and 25 cents a page.

Brian Elfert
06-23-2014, 1:51 PM
One of the big medical systems locally sent everyone's paper records to India to be put into their new electronic system. I don't know how it made sense to have someone in the USA scan in people's medical records and then send the data to India for transcription. Why not just do the work locally and skip the step of doing the scanning? (They only went back a few years.)

As long as my Social Security number isn't on those pages I guess there is nothing on my medical records that I would care if someone in India saw.

William Payer
06-23-2014, 1:54 PM
Mike,

I can access all my test results on line through Beaumont's portal. (need to have a participating Beaumont doctor). Its great in that I can access and print any test results, or see how any one particular test varied over time. Haven't gotten to the thumb drive option yet, but I can see where it could be very important and helpful in emergency situations.

Jason Roehl
06-23-2014, 5:31 PM
The 4th Amendment applies to being free from unreasonable search and seizures by government action--I don't think I see any government action here, nor do I understand the relationship to search and seizure.

Think about this: If I commission a woodworker to build me a custom set of cabinets, does that mean that I have the right to demand that he turns over all his paperwork and plans when he's done? The answers is "of course not." I'm not sure I see it any differently in the GP context. As for "he should do it for free," I see another side there too. If he's retiring, figure he has 50 years worth of medical records on thousands of patients. If he says "sure, just ask for them and I'll give them to you for free," he's going to spend the next year sorting through things and it will probably cost him tens of thousands of dollars. On the other hand, if he raises the bar a bit so only the people that are really interested take him up on it, he can probably close his doors faster. Just sayin'.


You haven't read the 4th amendment recently, have you? It doesn't say specifically that being secure in one's person and effects is only a right to security against the government. If a doctor is holding records about my treatment, condition and/or well-being then I can't very well oversee their security now, can I?

There's a big difference between records on an item (and, yes, I'd probably want a copy of specifications...) and records on a person which can be used if the info falls into the wrong hands to deny that person a loan or insurance or whatever else.

Eric DeSilva
06-23-2014, 5:52 PM
I would hazard a guess that HIPAA wouldn't permit you to simply hire someone at minimum wage to do this.

Eric DeSilva
06-23-2014, 6:11 PM
You haven't read the 4th amendment recently, have you? It doesn't say specifically that being secure in one's person and effects is only a right to security against the government. If a doctor is holding records about my treatment, condition and/or well-being then I can't very well oversee their security now, can I?

I haven't read the 4th Amendment recently, but thankfully the Bill of Rights doesn't change much. If you don't believe me, try: (i) http://criminal.findlaw.com/criminal-rights/when-the-fourth-amendment-applies.html (note second paragraph stating "[t]he Fourth Amendment only protects against searches and seizures conducted by the government or pursuant to a governmental direction"); (ii) http://en.wikipedia.org/wiki/Fourth_Amendment_to_the_United_States_Constitution (under "Applicability" it states "[t]he amendment applies to governmental searches and seizures, but not those done by private citizens or organizations who are not acting on behalf of a government").

There are also very, very strict rules under HIPAA regarding disclosure of health records. Having a copy doesn't protect you from unauthorized disclosure in any event. At the end of the day, ownership is silly to argue. It is well established that patients do not own their medical records, but that they are entitled to copies of such records (with some exceptions) with reasonable charges. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1560890/

Jason Roehl
06-23-2014, 7:58 PM
Having a copy doesn't protect you from unauthorized disclosure in any event. At the end of the day, ownership is silly to argue. It is well established that patients do not own their medical records,

Having the ONLY copy does help protect against unauthorized disclosure. And again, "well established" does not mean good, right or proper. Just because there are strict laws (in HIPAA) about something doesn't mean they are strictly followed or enforced.

Myk Rian
06-23-2014, 8:27 PM
Looks like I don't need a copy. I saw my Doctor last week, and my file was 4" thick. Damned if I'll pay to get that copied.

Eric DeSilva
06-24-2014, 9:00 AM
Jason, you seem to have a strong sense of right and wrong about this--but that doesn't mean that everyone would agree with you. Certainly the courts disagree in the sense that they consider it settled that medical records belong to the physician that created them.

I'm not sure when this became about having the "only" copy, although I'd agree with you that if you actually did own the records, you could assert a right to retain the only copy. Perhaps that is why you don't own them--the physician has a number of reasons to keep copies, including liability protection, billing and assisting in future diagnoses, so I see very little chance that they would agree to destroy their records and leave you with the only copy--that may not even be legal. Most of the physicians that I know--and the institutions they work for--take HIPAA pretty seriously, even to the point of impairing the sharing of records that could actually advance medical science. If you don't believe your physician is complying with HIPAA, find another doctor.

Dave Sheldrake
06-24-2014, 11:00 AM
Is there anything over there that isn't charged for at silly rates?? ;)

Here I can have a full original copy of all my medical records including notes for the cost of a letter and 1 to my doctor, the files are also held centrally on the NHS computers so any treatments are shared between hospitals and any doctor who needs to see them. If I got to a hospital in Scotland even though I am registered in Wales they can simply click a button on the PC and have access to all my files.

cheers

Dave

David Weaver
06-24-2014, 11:09 AM
Is there anything over there that isn't charged for at silly rates?? ;)

Gasoline and blue jeans, I guess.

Mike Cutler
06-24-2014, 12:05 PM
It's pretty normal, though it goes state by state. I think it's also pretty common that if another doctor requests the records to provide you care, they do NOT charge.

So have her new doctor make the request, and that's that.

But I don't know this for a fact...I'm going off of vague memory.

John

In Connecticut, at least in my experience, the records are your and you can request them anytime.
Three months ago all of my wives records, including imaging, were sent from Backus in Norwich to Smilow at Yale St. Raphael's in New Haven. We also were given a copy of all records. the only records that there was fee for was the imaging because they are converted from their program file format to one that can be read on a standard PC.
At Yale your records and testing results are uploaded to a computer and then are available to you online, with the exception of images because of their file format.

As for Bruce's original question; No it doesn't seem right. In Connecticut, at least, those records are his wife's, but more importantly they have to be conveyed to another physician's office. They just don't go into a box in the cellar. I would be asking to have the records transferred to another physicians office of my choice, before they are transferred to the physician(s) that are taking over her retiring physician's practice.

Roger Feeley
06-25-2014, 10:16 PM
I believe that the Dr. doesn't just turn over the records they have. They must keep your records on file for some period of time. I think when my dad retired from Dentistry, he told me that he had to maintain records for 10 years. That meant when he sold his practice, part of the deal was that all the records had to be copied so he could put them in his basement and ignore them.

I would bet that this Dr is charging a fee to make copies of your records.

Frank Drew
06-27-2014, 1:42 PM
You haven't read the 4th amendment recently, have you? It doesn't say specifically that being secure in one's person and effects is only a right to security against the government. If a doctor is holding records about my treatment, condition and/or well-being then I can't very well oversee their security now, can I?

I'm sympathetic to the idea that we should own our personal medical records, but that's a novel reading of the 4th amendment, Jason; I'm aware of no successful 4th amendment claims in disputes between private individuals. AFAIK, it has, since its adoption in 1792, involved searches and seizures by government authorities. "Fourth Amendment case law deals with three central questions: what government activities constitute "search" and "seizure"; what constitutes probable cause for these actions; and how violations of Fourth Amendment rights should be addressed."

But please provide contrary citations if you find any.

Joe Mioux
06-27-2014, 7:52 PM
I haven't read everyone's comments, but how hard is it for the Dr's staff to just go over to the filing cabinet and hand over the records? If the records go unclaimed I bet they wind up in a land fill. No?

Mike Henderson
06-28-2014, 12:31 AM
I haven't read everyone's comments, but how hard is it for the Dr's staff to just go over to the filing cabinet and hand over the records? If the records go unclaimed I bet they wind up in a land fill. No?
You can be sure they don't go into the landfill unless they're shredded.

Mike