Hurdles to Accessing One’s PHI

What is a fair price to charge a consumer to provide them a copy of their records? That is a question I’ve been pondering since a friend of mine showed me the bill from the local Steward IDN which is owned by private equity fund, Cerebus.

My friend is switching doctors due to a change by her employer in health plans. As a result, she requested a copy of her records to bring with here to her new physician. Seems like a pretty simple, straight-forward request. Steward was more than happy to provide those 10 pages of records and following is the cost breakdown they wished to charge her:

Clerical fee: $18.04
Cost/pg: $0.61
Mailing cost: $1.16

Total Cost:  $25.30

Two dollars and fifty cents a page – Outrageous!

When I asked for a full copy of my pet’s records, about 20pgs, the Vet was more than happy to oblige, for free. When I asked for  full copy of my car repair records (5yrs worth) as I was selling the car, my local mechanic was more than happy to oblige, again for free. So why is that when one asks for a copy of their medical records, which frankly they already paid for in their office visit charges, a company like Cerebus/Steward feels they have the right to charge such an exorbitant sum? Creating such hurdles to a patient’s ability to access their own personal health information (PHI) does nothing to improve healthcare delivery. Its time to put an end to such charges once and for all.

Sad thing about this whole story though is that under Massachusetts statute, Steward is allowed to charge up to $25.00. They discounted the bill $0.30 and lowered the bill to $25.00  Needless to say, I advised my friend to ignore the bill.

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15 thoughts on “Hurdles to Accessing One’s PHI

  1. This seems to be pretty standard with offices I’ve worked with. I suspect most states have a similar cap, and that most practices charge similarly (and probably up to the level of the cap).

    Part of the reasoning is that for some patients a records request is actually a real headache – I know at least one practice that has someone from an outside service come in once a week with a good scanner and he spends a morning disassembling charts, scanning them and reassembling. I think those are for legal discovery, but I wouldn’t be surprised if that’s what they do for patient requests as well. Some charts are 2-3 folders, totaling up to 6+ inches of paper. Some charts (if the patient hasn’t been in for a few years) are offsite (at Iron Mountain for the practice I’m thinking of), and they actually have to send a request to have the chart retrieved and are charged for it.

    • This is one reason why we need to move to digital records as it will eliminate such a burden for Drs’ offices and enable a patient to potentially be a more knowledgeable and engaged patient. And while I understand that a small fee may be reasonable for a large set of records (I still think we already paid for them and should have unfettered access) the $25. charge my friend received for 10pgs is highway robbery.

  2. Most facilities do outsource to companies like HealthPort, and some companies that handle that outsourcing also handle the billing of the patients for those record requests. In some cases this bill comes as a shock to the patient AFTER they have received the records.

  3. What if the new doctors office requested the records for continuing care purposes instead of the patient? The patient would sign the release of information request stating their records should be sent to the new doctors office. I myself have done this before. I’m not sure if the new doctors office is charged for the record copies. I’ve never heard of them being charged for the copies. This gives the new doctor more time to review the patients records too before their first visit.

  4. I would suggest paying the bill. A couple of years ago when I was switching doctors, I requested a copy of my file to be sent to my new doc. They sent me an outrageous bill, no quote in advance. I decided to “ignore” the ridiculous bill and the doctor’s office turned it over to a collection agency. When I contacted my insurance provider and the Medical Association for guidance, I was told that doctor’s are within their rights to charge fees. Ugh! It doesn’t seem right when I can pull my Explanation of Benefits from my insurance carriers website…but unfortunately those don’t show the whole story.

  5. I actually went through this also. I was going to get my records for which I would be charged. I was told that if my new doctor requested the records and I signed a release form there would be no charge. This seems to be an expensive road block for those wishing to keep up their own PHR.

    • It is an expensive roadblock Scott and one that needs to change. Just can’t figure out, as I wrote in the post, why others have no problems providing you copies of your records but HCOs do. As another commenter put it, there are times when records can be quite large (in excess of 100pgs). For such, if you want a print-out a reasonable charge I’m ok with. But if I want my records as a digital PDF – just send it to me via email, for free and let me take i from there. Shame that some institutions are still in the dark ages and Steward is far from being an outlier.

  6. Agreed. Also, if the burden for one’s own care is to be shared between patient and providers, patients need that information! In the past I requested and reviewed my records and immediately found 1) info. I would have liked to know but was not informed of 2) errors.

    • And that’s the sad thing Jennifer in that these institutions still treat patients not like customers but someone who should be privileged to receive their services. This type of mindset needs to change and we need far greater transparency and ease of access to our records.

  7. Yet another reason that the world needs HealthVault — by sending that information electronically (even as scans), it has far more utility for the patient and costs far less for the provider to produce. Just saying!

    • I’m with you Sean and suggested such but IDN refused to provide a digital copy and they had no patient portal that supported portability. Not for long though as I’m sure meaningful use will get them to change their ways, or at least their processes.

  8. Meaningful use core measure 12 – electronic copy of health information and meaningful use core measure 13 – clinical summaries will eventually change patients access to their own PHI.

    Here is a YouTube link I found outlining these 2 core measures:

    http://youtu.be/98n-p1_15ZA

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