Paul Sanchez
Patients have a legal right to a copy of their medical records, but fees for these copies vary across the US. While some hospitals provide free copies of medical records, others charge hundreds of dollars. These fees can be a serious financial impediment to patients obtaining their records. Copy fees for insurance companies are usually higher than those for patients. This article will explore the topic of medical record copy fees and whether insurance records are subject to the same charges.
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What You'll Learn
State laws and fees
State laws typically allow medical providers to charge a per-page copy fee, a flat fee for the entire medical record, or a combination of both. However, the fees charged must be reasonable and cost-based, as per the HIPAA Privacy Rule's right of access provisions. This rule supersedes state law, and the concept of a "reasonable fee" is flexible and depends on the number of pages.
- Alabama: $1 per page for the first 25 pages, 50 cents per page for each additional page, and a search fee of $5. The provider may also charge the actual cost of mailing the records and reproducing X-rays and other special medical records.
- Alaska: While patients have the right to inspect and copy their medical records, there is no state law limiting the costs of providing copies.
- Illinois: Effective January 1, 2022, there is no charge for "one complete copy of a patient's records," which includes any updated medical records, if the records are being requested by the patient or an authorized individual/entity for specific purposes.
- Indiana: The Department of Insurance sets the rules for making and providing copies of medical records. The maximum copying fees are $1 per page for the first 10 pages and 50 cents per page for subsequent pages.
- West Virginia: For non-indigent patients, the medical provider may charge a fee consistent with HIPAA, not exceeding 40 cents per page, a $20 search and handling fee, mailing costs, and applicable taxes. For electronic records, the fees cannot exceed $150, and a provider can charge $10 for a certified copy.
- Wisconsin: If a patient or their authorized representative requests medical records to appeal the denial of a Social Security disability insurance or Supplemental Security Income claim, the medical provider cannot charge more than the reimbursement rate set by the federal Social Security Administration, which is currently 10 cents per page.
- New Hampshire: Hospitals and clinics charge a search fee of $10. For the first 100 pages, the fee is $1 per page, and for pages beyond 100, it is 25 cents per page, with a maximum fee of $200.
- Tennessee: Hospital records have a flat fee of $48.10 for the first 10 pages, $1.62 per page for pages 11-60, 79 cents per page for pages 61-400, and 43 cents per page for pages beyond 400.
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Patient rights
Patients have a legal right under the Health Insurance Portability and Accountability Act (HIPAA) to obtain a copy of their medical records. This includes billing and payment records, insurance information, clinical laboratory test results, medical images, and clinical case notes. This right is protected by the HIPAA Privacy Rule, which establishes a minimum federal standard for protecting patient privacy and providing access to medical records.
State laws typically permit providers to charge a per-page copy fee or a flat fee for the entire medical record. However, the HIPAA Privacy Rule's right of access provisions stipulate that medical record copy fees must be reasonable and cost-based. This means that the fee should be based on the actual costs of reproduction and labour for copying the requested information. Fees for medical record copies can range from $2-55 for short records of 15 pages to $15-585 for longer records of 500 pages.
Individuals have the right to receive their medical records in the form and format requested or agreed upon, such as electronically or on paper. They also have the right to have their information mailed or emailed to them without having to purchase portable media. Additionally, patients are not required to pay for labour to prepare an explanation or summary of their health information unless they agree to any associated fees in advance.
While patients have broad access rights to their health information, there are some exceptions. For example, individuals do not have a right to access protected health information (PHI) that is not part of a designated record set, such as certain quality assessment records or business planning records. Similarly, clinical laboratories are not required to interpret test results for patients, but patients have the right to inspect or receive a copy of their completed test reports.
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X-rays and other media
In some cases, X-ray copies may be provided on a CD for a flat fee, which some patients may consider expensive. The cost of X-ray copies can vary depending on the reproduction costs, with some states charging a flat fee plus reasonable production costs. For example, hospitals in New Hampshire may charge a $20 flat fee for X-rays, while other healthcare providers in the state may charge a $10 flat fee, both plus reasonable production costs.
It is important to note that the concept of a "reasonable fee" is flexible and can depend on factors such as the number of pages, labour, and supply and postage costs. While patients have a legal right to obtain a copy of their medical records, the fees for X-ray copies can vary significantly across different states and healthcare providers.
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Social Security and SSI claims
The SSA requires you to send all medical documentation and evidence relevant to your disability from all your doctors and medical specialists. This is to prove that your condition is debilitating and prevents you from achieving sustainable gainful activity (SGA) before they begin sending you a monthly disability check. The SSA will also ask your treating physician, doctors, psychologists, and/or any other medical specialists to provide a medical report(s) on the applicant’s condition.
The SSA covers the costs of obtaining medical records up to a certain amount, but you will be responsible for any fees if you get your own records. The SSA must request your records as part of its evaluation process, so sending your own records would be like doing it twice. The exception to the rule is if your condition is on the SSA’s compassionate allowance list. You can upload your diagnosis with your initial application to expedite the process.
In the case of Social Security and SSI claims, many states have laws that waive or limit the amount medical providers can charge for providing copies of medical records. Some states have limits that apply to all requests, while other states have no limits at all. For example, in California, one free copy of a patient’s medical records can be provided to "a patient, employee of a nonprofit legal services entity representing the patient, or the personal representative of a patient" if the records are needed to support a claim or appeal regarding eligibility for a public benefit program, which includes Social Security Disability Insurance Benefits and Supplemental Security Income benefits. In Washington, one free copy of a patient’s medical records can be provided every two years if the patient is appealing the denial of SSI or Social Security disability benefits. In Massachusetts, existing medical records should be provided free of charge for SSI or SSD applicants by hospitals, clinics, health stops, and copying services.
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Search fees
The search fees for medical record copies vary from state to state in the US. Here is a list of search fees for a few states:
Alabama
The search fee for medical records in Alabama is $5. Pages 1-25 are charged at $1 per page, and pages 26 and beyond are $0.50 per page.
Arizona
Arizona does not have specific medical record copying fees to set pricing limitations. The search fee is a $15 flat fee per page. Pages 1-25 are charged at $0.50 per page, and pages 26 and beyond are $0.25 per page. A reasonable retrieval fee may be charged for off-site records.
New Hampshire
The search fee for electronic records in New Hampshire is $25.34. Pages 1 and beyond are charged at $0.58 per page, with a maximum fee of $111.03.
For paper records, the search fee is $20, and pages 1 and beyond are $0.50 per page. X-rays and other media are charged at the actual cost of reproduction.
Texas
The search fee for paper records in Texas is $21.16. Pages 1-40 are charged at $0.53 per page, and pages 41 and beyond are $0.32 per page.
For electronic records requested before 6/30/18, the per-page fee is 60% of the per-page fee for paper records. For requests made on or after 7/1/18, the per-page fee is 50% of the paper records per-page fee.
Wyoming
Wyoming does not have specific medical record copying fees but requires fees to be cost-based. The search fee for worker's comp electronic records is a flat fee of $26, while the fee for paper records is $7.50 (including pages 1-16). Page 17 and beyond are charged at $0.45 per page.
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Frequently asked questions
Copy fees set for attorneys and insurance companies are usually higher than those for patients. However, fees for insurance companies are typically lower than those for attorneys not representing the patient.
The cost of obtaining medical records varies across the US. Fees range from $2-55 for records of 15 pages, and $15-585 for 500 pages. In some states, such as Alabama, the cost is $1 per page for the first 25 pages, and 50 cents for each additional page. In other states, such as West Virginia, the fee is 40 cents per page.
Yes, many states have laws that waive or limit fees when the request is made in connection with a Social Security disability or SSI claim. In some states, such as Illinois, there is no charge for a complete copy of a patient's records if they are applying for Social Security benefits.
The cost of medical record copy fees is influenced by the number of pages, the format of the records (paper or electronic), and the location of the request (varying by state and city).
