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30 Responses

  1. Karen
    Karen January 14, 2009 at 6:34 am | | Reply

    That has got to be one of the most ridiculous things I’ve heard!! Good for you, standing up for yourself. I’m so glad she waived the stupid fee.

  2. Molave
    Molave January 14, 2009 at 6:38 am | | Reply

    Wow, twenty dollars to pay a processing fee? In the Philippines, that’s almost three days’ salary for a minimum wage earner. And we Filipinos thought OUR health care was expensive…

    Great post. And you’re absolutely right: it’s your own data, and you should be able to access it for, at most, the cost of a fax or a postage stamp.

  3. tmana
    tmana January 14, 2009 at 7:27 am | | Reply

    I can understand the fee for hard copies, and I understand doctors’ reluctance to share records — but if Doctor A refers you to Specialist-Type B, s/he is going to want the Specialist to know why you were referred.

    As for me, I make sure my PCP sends me copies of all my labs. This way, *I* know what’s happening… and it’s easy enough to make copies if I need to. Not to mention that all of the information gets added into my Excel workbook, so I have trend analysis as well.

  4. Allison Blass
    Allison Blass January 14, 2009 at 7:30 am | | Reply

    $20? Holy crikey. That definitely is a scam! They can’t charge you to send your information. That’s more than they probably make in an hour!

    Now, I’ve had to fill out those disclosure forms a few times myself, especially when I was in college and needed my college doctor to send stuff about our conversations to my endocrinologist. The only way they can do that is if I give them permission to release my info. But they aren’t supposed to charge you!

    Maybe you should consider firing your gyno for having such inane office practices.

  5. Scott Strange
    Scott Strange January 14, 2009 at 8:05 am | | Reply

    Here in Kansas anyway, I believe they can charge to send records to other providers, tho I have never had anyone who did. They cannot charge for the records to be sent to you. The state also has regulations that state what the maximum charge can be.

    Maybe California has similar regulations?

  6. Grainne
    Grainne January 14, 2009 at 8:43 am | | Reply

    I hope you reported this to a superior in your doctor’s office – it sounds like this person just tried to extort $20 out of you and maybe has a little scam going????

  7. AngelaC
    AngelaC January 14, 2009 at 10:56 am | | Reply

    When I decided to stop using my unviersity’s student health care center, I had to pay a small fee to have my records copied and sent to my new doctor. It wasn’t nearly as much as your fee, only around $7, and was meant to cover the cost of photocopying all of the records and the mailing — and I had an extensive record (several sinus infections, my dm records, and an x-ray from a fall I took when I nearly broke my hip). I didn’t have a problem with it, since it was a fairly reasonable fee AND it was a published fee. I would request a copy of your ob-gyn’s fee schedule for cash customers. If in fact there is a fee for sending records to another doctor, it should be published there. FWIW, when I’ve seen specialists outside of my primary care doctor’s practice (e.g. my ob-gyn), they’ve always had me fill out a form to tell them which primary care doc to send the exam results to. If you didn’t fill out a similar form, perhaps you should ask them for one or perhaps you could bring a signed note stating that you want all of your records to be shared with your endo.

  8. Anne Findlay
    Anne Findlay January 14, 2009 at 11:58 am | | Reply

    If your doctor requests the records (instead of you doing it), it will probably be free, just FYI. But that requires your doctor to do it, which isn’t always an option. $20 is excessive, though!

  9. Bill Halper
    Bill Halper January 14, 2009 at 1:45 pm | | Reply

    Unfortunately, the $20 fee isn’t that unusual these days. It probably takes five minutes of staff time to pull your chart, fax the records and then refile the chart. If you figure that the labor+benefits+overhead cost for a staff person is between $60 and $75/hour, that works out to a $5 to $6 direct cost to the doctor.

    Since Medicare and insurance reimbursements have been reduced, private practitioners are trying to recoup whatever they can…I know of one local ob/gyn who netted less than $50K in 2007 after paying for her portion of the eight staff people, office expenses, malpractice insurance and an occasional lunch.

  10. Lee Ann Thill
    Lee Ann Thill January 14, 2009 at 1:45 pm | | Reply

    That’s ridiculous. I would have flipped out too. I’m trying to remember if I’d had to do anything like that, and I think I had to pay some doctor to get a copy of my records. The information was mine of course, but paper and labor? Only for a fee. It’s so aggravating it’s enough to make your head spin.

  11. Lora
    Lora January 14, 2009 at 2:37 pm | | Reply

    I’ve had the medical record fee thing happen, too. I’ve heard, at least in Illinois, that if you request the information for yourself, there’s a charge, but if you’re requesting it goes directly to another doctor, there’s no fee. Luckily I have one nice doctor who lets me request my files go to her, then she gives me a copy for my personal files.

    Still, a royal pain in the butt. I’m still waiting for medical records I request two years ago…

  12. Mandy
    Mandy January 14, 2009 at 3:46 pm | | Reply

    I got handed a patient letter at my endo’s office yesterday, that says they now charge $30 for FMLA forms & $15 for letters ( for airport, etc…).
    It also had specific etiquette for us (the patients) to follow at visits, and when calling the office. I understand procedure practices are necessary for a busy clinic, but it felt like more of a scolding…I mean please!

  13. April
    April January 14, 2009 at 4:51 pm | | Reply

    Not healthcare fees, but I got a statement from my credit card company saying that they were going to raise my APR from 6.49% to 14.99%. In tiny print, there was an option to opt out of the increase. I called, opted out, and the guy told me that it’s a just a way to confuse people and raise their interest if they don’t call by the deadline. Not only that, I opted out and they DROPPED my APR to 5.49%!!!! I seriously believe companies charge extra fees knowing that a lot of people are not going to complain and just accept it! Good for you for raising heck!

  14. Barbara
    Barbara January 14, 2009 at 7:26 pm | | Reply

    Having seen this issue from both sides (as a patient going through the tedious march to Soc. Sec. disability, as well as a former medical records clerk), my guess is that you were dealing with an uninformed or new employee. It was always a struggle to explain pricing to a new hire, and it inevitably caused misunderstandings such as yours. Our fee (this was 5 years ago) was $15 for the first 10 pages, then $0.25 for each additional page… but only if a patient or lawyer requested copies for themselves. We NEVER charged for records needed for patient care, such as those sent to another physician or hospital. As a matter of fact, I believe there are laws banning such charges, at least in our state. My best advice to anyone in your situation is to refuse such a fee & ask to speak to a supervisor, who will hopefully see the error & correct it. There is probably no getting around the fees for forms such as FMLA, however… These are incredibly time-consuming and labor intensive for office staff & physicians, so most providers charge a minimum of $20 for such services.

  15. Diane
    Diane January 14, 2009 at 8:20 pm | | Reply

    I have heard of this before, and it is ludicrous. I have had doctors’ offices mail my entire file with no charge, and others who fax or make calls for no charge. But more and more this charging for additional services is being used. A number of years ago I visited a dermatologist at the request of my doctor to view a very small mole. Being a new patient, I completed the mound of paperwork they required. I was in the waiting room an eternity (far past my appointment time). I saw his nurse eventually for a few minutes. Then the doctor saw me for maybe 5 minutes. When I got the bill I nearly fainted, it was so outrageous. But the “kicker” was the $35.00 “new patient file” charge. I did all the work filling out the paperwork and spent a ridiculous amount of time waiting for the doctor, and they charged ME $35.00 for being a new patient!

    I know that if you ask to come by and pick up paperwork to take to another doctor, that usually is best. While they may charge to mail it – or even fax it, which is absurd – there rarely is a charge for them to copy it and give it to you to hand deliver.

    The endocrinologist that I have been seeing for a couple of months (very large outfit) has signs posted everywhere that there is an additional charge if you do not get all of your prescription refills while there for your visit. If they have to phone it in or fax it, there’s an extra charge. I cannot remember just what it was, but I remember thinking it was very high.

    This is the world we live in, folks. Doubt it will get any better.

  16. Amy
    Amy January 14, 2009 at 8:24 pm | | Reply

    I used to do HIPAA education; there’s a provision in the law for medical facilities to charge “reasonable” fees for putting info into another doc’s hands with your OK. Best bet: Always ask for a copy of your test results when you are at the original provider’s office (e.g., if you have a mammo ordered, ask the radiology place how to get your own copy, don’t take no for an answer as HIPAA also says they’re your records). If it’s any help to them, you can always offer to provide a SASE for them up front.
    What they’re trying to recoup is the overtime.
    I could add a ton more info. Maybe someday I’ll start a blog that explains things in more detail (but first, I have to take care of a sick elder and get a job before we’re living in the conversion van).

  17. Dave
    Dave January 14, 2009 at 9:08 pm | | Reply

    Hmmm last time I checked my co-pay and the insurance company paid for the test so therefore the results are mine. I would be telling them I will be over to pick them up. $20 bucks, F..k that, this is the kind of stuff that makes my blood boil. When businesses need money they fee the life right out of you, a dollar here and 5 dollars there which is bad enough but when they go for the jugular and try charge $20 bucks no way!!! Good for you for standing up to them. Their policy is probably to squeeze $20 from people who don’t complain get a live one on the phone, such as what you said and they back off.

    Thanks for the good post-Dave

  18. Amy
    Amy January 14, 2009 at 10:31 pm | | Reply

    As a PS to my post on the cost of the records above, I didn’t explain something else that might help you understand.
    Many MD offices are now “outsourcing” medical records maintenance. This keeps down insurance premiums for the practice, which is already loaded down with malpractice, fire, & general liability insurances, and a baseline fee for a legal consultant.
    These companies come in to the offices once or more a week, and take all requests for records; they make the copies and package them up and send them to the patient or MD office (I argue you should have them sent to you; make copies for them to have yourself and lock up the first set of copies in a safe place; or scan and fax if you have an all-in-one printer with that capability).
    From what I have heard, these records copying companies about guarantee that any records they handle won’t be subject to HIPAA fines as long as the office follows their guidelines and uses their HIPAA lawyer approved fines. Considering the cost to a facility of just one HIPAA violation (HIGH!!!!), the use of outsourced companies that specialize in that function makes a lot more sense to doctors than you’d think.
    To make those HIPAA compliant guarantees, especially when HIPAA regs tighten up all the time, these places would have to keep extensive legal staffs on hand to do this. So they pass the price on to the doctors in the form of a base fee plus a certain amount over that for each copy “job.” The copy costs are passed on to you – and probably, they round them off a bit to allow for the time and effort it takes them to process all the requests they receive in a day – which, in a large practice, is quite a few.
    Small 1 – 2 MD practices might not do this, and a lot of even large practices or hospitals will not charge you for the first 1 – 3 sets of records, but after that, it’s more. It all depends, a lot of it depends on the size of the records involved. Obviously, faxing 1 – 3 sheets of labwork isn’t as pricely as a chart the size most of us have, and doesn’t take as long. That’s why most people do keep a copy of their own charts and labwork and just take it with them.

  19. JudyK
    JudyK January 15, 2009 at 7:41 am | | Reply

    Sorry to say that this practice and charge has been going on for some time! Ten years ago, my daughter was asked to pay to have her records sent to a doctor in the town she had moved to. She could come home, tho’, ask for those same records copied and given to her and she took the records to the new doctor with only a small charge for copies.
    I always ask that my lab results be mailed to me or faxed to me for my own records. Until I asked for them, I listened to a phone recording of what the doctor wanted to tell me!!! Since they are MY lab results, I WILL get the whole report for my files!
    You should ask for a printout of hospital charges too. You would probably be surprised what you were charged for and how much you were charged!! My Dad’s last visit to the hospital, we had to bring one of his meds with us because the hospital didn’t keep it in stock. After a few days, however, they ordered it in and we were asked to take his personal supply home. Would you believe the hospital charged for that medication for the first couple of days when they were dispensing from his personal supply from home?!!

  20. jeremiah
    jeremiah January 15, 2009 at 10:31 am | | Reply

    welcome to the wondeful world of forprofit healthcare, where your health is less important than a dead president’s face on paper. i truly only think unless things change drastically that this is just the tip of the iceberg, mark my words soon you will be seeing the same things going on as they do now in banking nickel and diming everywhere until that isn’t enough and those nickel and dimes turn into ten’s and twenties as in the case you have. it is a crime you know as a self pay patient or any patient but i can’t walk in to a lab and request bloodwork done on my own body so i know what is happening oh no, i have to pay a doctor to order than pay to get it done and don’t forget besides the doctor’s bill you have a sepereate bill for the use of space in the hospital of and the same applies when you get your blood work done a bill for the labs, and a seperate one for the facility. it is to the point that you begin to ask what it is your orginal doctor visit is supposed to cover? am i paying this large amount just for you to check my blood pressure and tickle my feet or as i think i would have adminstrative fees covered etc..

  21. Lauren
    Lauren January 15, 2009 at 11:50 pm | | Reply

    Yes, there are laws governing access to your records. Doctors have to provide them within a certain time limit and they are definitely limited to the charges they can apply. If this incident upset you that much, contact the board immediately and file a complaint.

    People go through far, far worse every day, dealing with the train wreck that is health care in America.

    Whenever I’m a patient, I make sure to know my rights and know exactly whom to contact if I need to involve an outside agency. I also document everything, get names, and write down dates of conversations.

  22. Brenda
    Brenda January 16, 2009 at 9:24 am | | Reply

    You should just make it a habit to get copies of all your test results yourself, whether it be electronically (so you can print it out) or on paper. Then you can just hand your other doctors your records, cutting out the middle man. I have a fax service where I have faxes sent to a phone number, and the service sends me a PDF of the fax. Assuming the doc’s office is amenable to faxing results to me, I have an instant electronic copy in my inbox that I can file on my computer and print out for my files.

  23. Scott
    Scott January 18, 2009 at 8:31 am | | Reply

    Everyone, it’s very simple why this is happening. Doctors are now getting squeezed so much by insurance companies setting negotiated prices that they can no longer stay in business just charging the allowed amounts. Hence, they need to make money some other way.

    In the state where I live (Ohio), over 40% of the OB-GYNs have gone out of business in the last 5 or so years.

    You should be sending them the $20 as a thank you for even staying in business. I’m not disagreeing at all that this should be a “for free” service, but because of the way insurance is killing us all….

    Scott

  24. jeremiah
    jeremiah January 18, 2009 at 9:55 am | | Reply

    Scott,

    you do realize that doctors don’t have to accept insurance, and in doing so can lower their office visits to the patients since the don’t have to ballon their costs to only settle at a lower price with the insurance companies while milking a self-pay person as myself. sorry but a $200 dollar visit to an endo for him to check my B.P. tickle my feet and tell me the low you had on X day is a concern to him. isn’t worth 200 bucks and you say i ought to be happy to give them an extra 20 dollars are you off your rocker man!!! the last time i checked most docs are driving a 600 benz or 745li bmw, while a small business owners as myself puts in 18 hours a day just to be able to pay employees buy insulin and over pay these crack doctors. as a matter of fact they ought to be happy to hand me a 20 dollar bill for going to see them instead of someone else. not only are you a patient but you are the consumer in a for profit health industry that borders corruption and fraud.

  25. kelly close
    kelly close January 18, 2009 at 6:16 pm | | Reply

    Amy, I know, where are things going! Hopefully with the new Obama administration, we’ll be moving toward electronic medical records although there was just an article on today’s NY Times about how privacy is such a problem there. Distressing! We know reimbursement is a major difficulty for so many people with diabetes – it’s very hard for doctors too who just want to spend time with patients. My (our!) doctor is often in her office at 7 pm and gets paid incredibly little for her time. The days of doctors with fancy cars is ending. All doctors need to be able to communicate with and share info with each other MUCH more easily to keep us healthier, so we can get better care and do well in the long run – and so they can stay in business. I hope this is a bigger area of investment going forward. best kelly http://www.HealTheFDA.com

  26. Melissa
    Melissa January 19, 2009 at 1:53 pm | | Reply

    It’s only going to get worse. I’ve just been informed that I have to take a “healthy benefits” assessment and then complete 2 “wellness” programs or the cost of my health insurance will go up $20 on the co-pay, $250 on the deductible and $750 on the flex account. Oh, of course this is all “optional”, but if you don’t do it you pay higher. Sounds like extortion to me. And apparently we have to do this every year now. How they are going to work that is beyond me as there are only around 5 wellness courses to take, what happens after you’ve done everything you can and taken all the classes? What happens if you decide not to do it for 3 years, does that mean your co-pay goes up $60?!? My current co-pay just went up $5 to $15 instead of $10 – add 3 years of $20 for not taking their stupid courses and my co-pay for an office visit would be $75!

    It’s a vicious cycle, they raise healthcare costs and more people can’t afford health insurance, so they raise them again, and more people can’t afford it. We’ll end up with socialized medicine in the end if by no other means than the fact that eventually absolutely no one will be able to afford health insurance and we’ll all be on the public trough.

  27. Stalwart Hospitalist
    Stalwart Hospitalist January 20, 2009 at 10:24 am | | Reply

    I would advise that some of this energy be channeled into lobbying for a support of a national health care record, obviating the need for record faxing of any kind, and eliminating the inefficiencies associated therewith.

    As a hospitalist, I yearn for the day when I do not have to spend any extra time with other hospitals’ or clinics’ medical record personnel in order to obtain needed information on my patients.

    In addition, this would remove the current false dilemma of patients having to decide whether to spend the extra time to transport records themselves or having to pay an extra fee for medical personnel to do so.

  28. Absolutely Absured
    Absolutely Absured January 28, 2009 at 1:00 am | | Reply

    Hello, I’m not exactly sure Who I am responding to, but I had to RESPOND!

    This is absolutely ludicrous, I am appalled. I am angry, but I also understand what the hospitals and Dr’s offices are doing. I see it all around us. I see it in pharmacies also. This is an interpretation of HIPPA laws or CMS or Medicare. Everyone is going extremely overboard with this. For your own medical record, to have to pay for another physician’s office to receive a FAX a copy of your medical records. Man, I see a Pandora’s box here. We’ll be charged for the service, Okay, of course it will continue to escalate to an absorbitant rate. then again we will be charged for the copy we want, and again be charged to have it forwarded to the other Dr. will we eventually be EACH and EVERY single time!!!!!

    This is absolutely ridiculous. It’s sheer laziness. Someone has to lift one more piece of paper or make one more phone call or punch one more button on a fax machine. I could go on and on.

    I realize we are ALL busy. EVERYONE. No one is immune to the fast pace world today. Some choose it, some don’t choose it, some cause it, some ignore it, making everyone else more crazy and more busy. Geez, this will never end, will it?

    Anyway, back to what I was talking about. You make a request, the office wants a release signed. Okay, no problem and really no problem to make the phone calls. This isn’t really any one person or Dr’s office staff’s responsibility. I think we can all share this task. However, with the way it’s going, certainly no one will volunteer to do this task. (Would you?) Let’s Pretend or go with what you did, make the phone call with the request. Wonderful the ball’s rolling. Now, WE make the call to verify that everything has been sent where it needs to go and the Dr’ office has the gull to ask you to pay a processing FEE! Excuse me, but good GOD. That is so Absolutely Lubricious. They just want more money. It’s almost as bad as hospitals writing off (I’m going to get in huge trouble here, but I’m on a roll) bills for people who can’t pay for the service. I completely agree everyone and I mean ABSOLUTELY EVERYONE should have access to care, but in most cases, individual’s with insurance (You all know the Routine) end up paying higher prices and also end up being charged SELF PAY for the portion the insurance doesn’t cover. (MOST HOSPITAL’S EXPECT YOU TO TAKE OUT A LOAN TO PAY THEM BACK.) They simply do not care. Whatever happened to taking the Medicare allowance or even taking insurance companies allowance as payment in full. Good LORD we all need help. We’re not going to make it much longer. (P.S. carefully scrutinize each and every bill)

    Okay, so now really, the Dr. wanted you to pay for the little extra work that someone had to do for you. It is our right as a patient to request a copy of our own medical record. Especially, it is right to request records to be sent to another physician. More often than not, most hospitals and Dr’s offices have some type of consent form that should cover this scenario. Yet, you still should NOT have to pay any more for it. GOT ME HERE?

    I instruct everyone I know to ask for a copy of anything done in the hospital or Dr’s office directly upon receipts of the results. Pretty soon, they will start CHARGING us for THOSE copies. Yet, if we keep on top of things we will have our own medical record and can make copies as we need them and transfer or submit the to another physician as needed. I certainly would recommend a place for safe keeping. Lock box, safe, whatever. At least you can do what you want. Something has got to change and soon. I pray.

    Pharmacies use to call your Dr’s office if you needed a refill authorization.However, now they will post a little sticker on the bottle to tell you to call him. Many are doing away with the answering machines now and you can’t reach them accept for during hours of operation. They refuse to make a phone call to report a need. They are TOO busy! Well then, do what most people do….GET HELP. Pretty soon, they will be calling us with questions regarding the prescription the Dr. wrote for you. That’s in the pharmacists job description isn’t it? ‘m just being facetious, I can make a call like this one too. I have no problem with that. Even though I don’t know anything about what he ordered or what or how to ask for something else. Bah Humug!!! This is crazy…

    Let us know what you think.

    It’s a viscious cycle and I completely understand the concept of accepting responsibility. I think we all do or most people do. I’m not trying to bad mouth anyone. Really I’m not. I’m just sick and tired of the chaos creating more chaos. What happened to “organized” chaos. At least thing got done, maybe not fast but dependably.

  29. Absolutely Absured
    Absolutely Absured January 28, 2009 at 1:15 am | | Reply

    Let me correct myself here. A hospital will write off a certain portion of an individual’s bill if they are self pay. A discount of sorts. If you will pay in full they will offer a huge discount at the time of discharge.
    I stand corrected or will correct further if needed!
    If you have insurance, they will accept what insurance pays and charge you the rest of the bill in full. Oh, excuse me if you work there some will offer a slight discount. A hospital will accept a Public Aid payment in full, but will not accept accept a Medicare payment if full. You are charged the remainder of the bill. Possibly minus a small percentage. I don’t pretend to be one hundred percent accuarate. I just know that this is the way some organizations do business.

    P.S. and they really don’t care if you have to take out a second mortgage either.

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