What rights do I have to get copies of my medical records?
Under the Health Insurance Portability and Accountability Act (HIPAA) you have the right to receive a copy of your medical and billing records held by health insurance plans and medical providers. You may have to pay for the cost of copying and mailing.
How do I obtain my records?
Most healthcare providers have procedures set up for the production of records. If you receive your treatment in a particular health care system such as the Hospital of the University of Pennsylvania, you can obtain access to electronic copies of your medical records through a patient portal by setting up an account online. For most other providers, you should make a written request with a HIPAA compliant authorization. Under HIPAA, your lawyer or personal representative has the right to access your records if you have given them permission to do so.
May my doctor force me to pay my medical bill to obtain a copy of my records?
Your doctor has the right to charge for reasonable costs for copying and mailing the records, but may not refuse to provide those records because you haven't paid for medical services.
How much will it cost to obtain copies of my medical records?
A healthcare facility or healthcare provider in Pennsylvania can charge you a fee of $1.46 per page for pages 1 to 20, $1.08 for pages 21 to 60, and $.36 for pages 61 to the end. Furthermore, there is a flat fee for production of records to support any claim "under Social Security or any federal or state financial needs-based program" of $27.48. Many other states limit the prices providers may charge for retrieving and copying records.
Should I limit my medical record request?
If you received extensive medical care or hospitalizations, obtaining a full set of your medical records can be expensive if they are not provided electronically. If you need medical records for a particular purpose, you should describe exactly what you want. If you had a long hospitalization, instead of asking for a full set of the hospital records, you can request a copy of the "abstract only," which will exclude minor medical records.
How long does it take to obtain copies of my records?
It is extremely unlikely that you'll be able to obtain copies of your records on the day you request them. HIPAA gives providers and health plans 30 days to respond to a record request. They can get a 30 day extension, but the plan or provider is supposed to explain to the requester the cause of the delay. As a practical matter, you may have to call the medical records department repeatedly to make sure that your request is processed. Large hospitals, for example, get thousands of requests from law enforcement officials, attorneys, patients, insurance companies, and other medical providers. The staffs responding to these requests are often not large enough to deal with the volume.
Are psychotherapy notes treated differently than personal health information?
While obtaining copies of health insurance information is fairly simple under HIPAA, there are special rules for psychotherapy notes, which are defined as notes recorded by a mental health professional regarding conversations during private, group, or family counseling sessions. These notes are kept separately from medical and billing records. Psychotherapy notes may not be disclosed by a medical provider without your express authorization except where the information is needed to prevent imminent and serious harm of a person or persons.
May my spouse obtain copies of my medical records?
No. For your spouse to have access to your medical records, you must sign an authorization, an advanced directive, or power of attorney.
Do I have full access to my children's medical records?
No. There are a number of situations in which parents do not have the right to obtain copies of their children’s medical records. For example, if a healthcare provider reasonably believes that a parent is abusing or neglecting a child, the provider has the right to refuse to provide those records to a parent. Once your child turns 18, he or she has full rights under HIPAA to obtain copies of their medical records, including records created when the child was under 18. Once your child is 18, you will no longer have the right to obtain copies of medical records merely because you are a parent. Furthermore, there are types of medical treatment to which you do not have access without the express permission of your child. For example, if your child under the age of 18 and is sexually active and undergoes testing for venereal diseases, the healthcare provider does not have the right to release those medical records to you your unless your child has authorized the release of these records.
What happens if I see an error in my medical records?
If there is an error in your medical or billing record, the healthcare provider or health plan must respond to a request that you make to change or amend the record. As a practical matter, if you are involved in litigation in which the medical records are relevant, you should not make such a request without consulting with your attorney.
I have a complicated medical history. What can I do to make sure that my doctors have accurate information?
Unfortunately you may find when you obtain copies of your medical records that a particular provider does not have in its possession a full set of all the records that are necessary for a complete understanding of your medical conditions. Furthermore, you may find that the records are disorganized. You may want to consider organizing your past medical records for use by a new medical provider. Lab results, diagnostic study reports, operative reports, prescription records, and physician’s reports should be grouped separately and placed in chronological order. Make sure any new medical provider has a complete understanding of all medications and medical devices that you are using.
In Pennsylvania, how long does my healthcare provider have to to keep copies of my medical records?
For minors, providers have to keep copies of medical records until one year after the minor reaches reaches the age of 18 or for seven years, whichever is longer. Most other medical records must be kept for seven years after the date of treatment.
What do I do if my healthcare provider refuses to produce my medical records?
In Pennsylvania, if a healthcare provider reasonably believes that releasing your medical records might endanger you or another person, the provider has the right to refuse to release those records. You have the right to request a different healthcare professional review the decision. At the time that the healthcare provider refuses to produce the records, the provider must explain to you how to ask for a review. The reviewer is chosen by your healthcare provider, not you, and the reviewing provider’s decision must be provided to you in writing.
What can I do if I believe it a healthcare plan or provider has violated my rights to obtain copies of or amend medical records?
You can file a complaint with the office for civil rights, Health and Human Services (OCR). You can obtain information about how to file such complaint by clicking here. You can also call OCR at (800) 368-1019.
You can also file a complaint with the Pennsylvania Department of State either online or by mail at the following address:
Pennsylvania Department of State
2601 N. 3rd St.
PO Box 2649
Harrisburg, PA 17105-2649
You can also call the complaints office hotline at (800) 822-2113 to obtain a copy of the complaint form.
For the definitive guide to making your way through the Pennsylvania workers’ compensation system, order a free paper copy of The Wounded Worker: Inside the Pennsylvania Workers’ Comp Maze by calling 877-959-1811 or download a free e-copy by clicking here.