Medical records fees and policies

This article covers the injustice of medical patients being charged monetary fees for, and having limited access to, their medical records, as well as a few concomitant double standards: (1) that medical professionals send medical records free of charge to other medical providers even when patients themselves are charged for them, (2) that medical professionals often keep patients' medical records only for limited amounts of time, and (3) that medical professionals' expect that patients produce past medical records for continuation of care.

## Background

In medical care, **medical records** are the documents that doctors, nurses, hospitals, and medical facilities keep regarding the care, diagnoses, and conditions of their patients. Medical records include, or are often synonymous with, a patient's **chart**. Medical records are very important in treating patients, by providing the available historical information any time that medical staff provide treatment to a patient.

Many medical professionals and facilities, especially hospitals, charge monetary fees to patients for the patients to obtain copies of their medical records. These are known as **medical records fees**. In most -- if not all -- cases, especially in the United States, patients are permitted to have copies of medical records sent to *other* medical professionals and doctors' offices free of charge, even when the patient himself/herself would be charged for obtaining copies of the records.

Typically, medical records fees are not covered by health insurance; the fees must be paid by patients out-of-pocket. The fees are often on a per-page basis. In the United States, laws such as the Health Insurance Portability and Accountability Act (HIPAA) govern patients' right of access to medical records.

Pundits have given some varying explanations as to patients would be charged for receiving records themselves while being permitted to have the records sent to other medical professionals for free. One explanation is that patients need to be charged to defray the costs involved in medical offices copying records, yet the free transfer of records to other medical professionals is a "professional courtesy" between practitioners in the medical field. Another explanation is that medical records are transferred for free to other medical professionals for the purpose of "**continuation of care**" and thus should be free, while implying that giving the records to patients themselves does not serve this purpose.

Sometimes, patients are permitted to claim indigency in order to have medical records fees reduced or waived, but the policies and practices for making this determination vary between medical offices and facilities, as well as between different legal jurisdictions.

### Limited retention time of medical records

In most cases, and increasingly, doctors' offices, hospitals, and medical facilities limit the amount of time that they keep medical records, typically due to the cost of retaining large numbers of records. The minimum amounts of time that records are retained are usually governed by laws especially in the United States; a commonly standard length of time is seven (7) years. After the retention time, records may be destroyed (such as by paper shredding).

### Requirement to produce past records to new doctors

Typically, when patients see a new physician, they are asked to provide their medical histories and copies of past medical records to the doctor. This is especially common in **new-patient paperwork** during a **new-patient appointment**. The past medical records and history assist the new physician in making diagnoses and providing treatment for ongoing medical conditions or based on past medical conditions.

### Use of medical records in requesting disability accommodations

Oftentimes, people need past medical records when requesting **disability accommodations** in settings such as employment and education. For example, this may often be true for people with mental, cognitive, and psychological disabilities such as autism. Disability accommodations are governed by laws such as the Americans with Disabilities Act in the United States, which state that a person may need to demonstrate a disability by having "a *record* of such an impairment" (emphasis added). Therefore, patients may need their own copies of medical records in order to prove disabilities for the purpose of requesting accommodations throughout their lifetimes.

## Arguments in favor of regarding as an injustice

Patients are often exorbitantly charged for their medical records. It is a highly unjust system when patients must pay these high amounts out-of-pocket for records that they need. It is a complete fallacy that giving patients their own records is not "continuation of care" -- in fact, when patients receive their records it typically *is* for continuation of care. Patients often need their records later in life, to provide to future doctors who ask for these records, and sometimes to prove the existence of a disability for the purpose of obtaining accommodations. Patients themselves are the people with the primary interest in medical records that are about them, and it is an unjust and insensible double standard that other medical practitioners can receive them for free while the patients cannot. It doesn't make sense that practitioners want to be able to destroy records after only a few years yet do not want to provide free records to patients that they often need later in life.

## Arguments against regarding as an injustice

It is expensive for medical practitioners to maintain and copy medical records. Medical professionals are the ones best equipped to utilize and interpret medical records whereas patients are not so well-equipped, so the professional courtesy of transferring records to other practitioners makes sense.