Hostile HIPAA

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Adding to my new experiences as a patient, I have now run into heretofore unforeseen side of the HIPAA monster. As a patient, it should be protecting me, right? Of course not! Legislated in part to protect privacy, HIPAA is one of the most misunderstood and abused laws by healthcare personnel, particularly clerical staff at the front lines of the patient-physician records interface who may not have much of a healthcare (or all that much educational) background to boot. 

In my case, I called wanting a report from a minor surgery a few weeks after I had it done. I had already called the surgeon’s office and they said that while they did have a copy via their electronic medical record (EMR), the actual operative report was the hospital’s property and they couldn’t give me a copy; they just had viewing privileges, I was told. In the past, I’ve received every copy of everything I’ve ever wanted. This “ownership” business was nonsense–after all, this was my surgeon and the paper copy was in my chart. As long as I was there and asked for it, a simple copy had always been made for me to walk out with said report in hand. To be clear, I’m talking about post-HIPAA, not some wistful recollection of the way things were back in the “good old days.” Said surgeon recently moved into a brand spanking new office, has a ton of new staff, and I just thought that this was just a miscommunication–escalating to a supervisor or the like should resolve the problem.

Obviously it didn’t, but the fun was just about to begin. My instructions–reasonable, I might add–were to contact the hospital’s medical records department since they “owned” the information, and they could help me further. It was speaking to the medical records (“MR” below, because I like the double-entendre) office that thing became unglued. Below is a faithful transcript of our conversation, edited only for general length and idle banter:

Me: [explain my needs] So what procedure do you have for me to get a copy of the report?
MR: You need to come by–in person only with a picture ID–fill out some paperwork and pay a processing fee that starts at $42.50 for first 10 pages.
Me: $42-what?! The report is just one page, I think–maybe 2 at most. I mean, it’s on the screen–just hit ‘Print’
Me: Doesn’t matter if it’s 1 page or 10; it’s the same price.
MR: But wait, my family doctor’s been FAXed records from here–did you charge his office too?
MR: No, we don’t charge physicians because the request is for continuation of care. If we give a copy to you it’s not for continuation of care, it’s for your personal use.
Me: But the same work is being done, you just aren’t charging the doctor but are charging the patient? So it’s not a cost recovery, you’re penalizing the patient.

MR: We give it to the doctor electronically [not true, only applies to affiliated doctors in same med center]. We charge you or an insurance company because we have to physically process the record [what, press "Print" from the screen interface?!?] If it the report is for a doctor, they can access it electronically.
Me: But the doctor is in [my home city, 35 miles away], he’s always gotten records by fax.
MR: Well, we just went live with our new system in October.
Me: But if your system wasn’t live, you’re still saying you would charge me and not him.
MR: That’s correct, but slightly less than $42.50.

Me: OK, but I’m saying my doctor I know has no login credentials to your hospital, no privileges, nothing. So how can he get a copy?
MR: I’m guessing he’ll have to apply for access, but–well–I don’t know–I’m not the one that handles that, but in the meantime if he can’t get to it online, someone will have to pull the records, process it [again, this is just a quick computer search that takes 5-10 seconds], and send him the records–
Me: –which is my point: you’ll have to send him the records manually, but you aren’t going to charge him for the same work you’re going to charge me–
MR:  –That’s right! [Proudly, as though she's won an argument b/c I'm agreeing, which was most disturbing]
Me:  –someone is going to have to physically process this–
MR: Yes sir! [again, defiantly]
Me:   –and send it to my physician without charging him.
MR: Yes, because it’s for continuation of care [emphasis theirs, spoken slowly] and that’s something very different.
Me: [previously explained about my having been in Mexico, do have a "continuation of care" issue for my own recordkeeping] I already told you, I need the records for a physician in Mexico.
MR: If you can provide us with the name and address, we can release the records to him and mail them.
Me: To Mexico?!?!
MR: Yes sir, we can mail them.

Me: You have no idea what mail is like in Mexico; it will take a month at least if at all. I doubt you’ll pay the $30 for FedEx for that one page. Besides, are you sure all these fees are consistent with HIPAA and state regulations concerning access, etc?
MR: Yes sir, I can even provide you with a fee schedule.
Me: Can you fax that to me?
MR: Of course, let me get your fax number.

And with that deliciously ironic ending, the “labor” and “pulling records” was equal to the fax of that one page which they were all too willing to perform for free so their fees could be proudly shared. The 10 minute phone converation could have pulled at least 5 records and faxed as many copies. This is robbery, plain and simple.

HIPAA was crafted for portability (change in jobs, location, etc. doesn’t make one “start over” in terms of coverage) and security/privacy above all. It is, in spirit, supposed to be protective of the insured at the unfortunate and unfunded responsibiity of the healthcare provider caught in between trying to both comply and do right by the patient. I sympathize with this, but to selectively push costs back on the patient and not a physician–or more to the point, another business entity capable of absorbing said costs as the price of doing business–is predatory and in stark contrast to the spirit of the law. Moreover, HIPAA left way too much open to vague enforcement with language like “reasonable fee.”  It’s no wonder that individual state agencies and other entities are pushing the envelope with what’s “allowable” at the patient’s (ie, the person most exploitable and vulnerable) expense.

In the end, I got my report–not by paying $42.50 to the hospital, but at my next surgeon’s visit, I simply asked him if I could get a copy.  Without hesitation, he said “Sure!” and directed his nurse to go up front and make a copy for me on my way out.  Done. Piece of cake. HIPAA be damned.

  • By Robin, November 22, 2008 @ 11:03 am

    I’ve dealt with the same issue for several years during my Cushing’s testing, diagnosis, surgery, and aftercare. I had to work with my doctors to fix this.

    Now, every form that is filled out by me and my endocrinologist includes my fax number so that all reports will be faxed to me, also. Frankly, I doubt most places realize that fax number is not his. They don’t seem to mind if there are two fax numbers. Most things he can get via the internet/digitally so the fax is redundant anyhow.

    Oh, something we’ve found out in the Cushing’s community is that if a state law is more protective of the patient, then it takes precedence over HIPAA. This can sometimes cause major problems getting information. And if one’s doctor is in one state and one lives in another state, it then becomes tougher. But we’ve learned how to circumvent it and what wording to use to get our own records.

    Most of all, thank you for sharing your story. I can empathize, and I appreciate it. I’m sorry you are ill, and I wish you the best.

  • By Karl, November 22, 2008 @ 6:56 pm

    Yeah, the entire medical records access system is totally confused now. Its been
    coopted by the Hospital industry to charge absurd “processing” fees, it creates legal issues when you try to access records across State lines or from Federal jurisdiction, State Laws contradict Federal ones….just a confusing mess and now people are getting venal about it. Just one more thing that badly needs fixing. This was
    all created, as you say, to give the patient control over their records ie. any number of times as a Resident they would repeatedly emphasize how “its the patient that owns their medical records not the Hospital”. But, we’re not really seeing that now…frustrating.

  • By Kim, November 23, 2008 @ 1:24 am

    And you kept your cool through all that? That’s more than I would have been able to do! : 0

  • By dragonfly, November 23, 2008 @ 4:48 am

    Good grief. I could see myself getting MUY frustrated with that. So you are still in Mexico with your family? What are you doing there?

  • By Celeste, November 24, 2008 @ 9:18 am

    Sorry for the go-round you had with THAT EPIC LOSER, but how cool that your actual doctor made it happen for you. You just know that little twit on the phone prides herself on how well she does her job…her petty, stupid little job.

  • By Couch Pundit, November 24, 2008 @ 3:56 pm

    That reminds me of Terry Gilliam’s “Brazil” I can’t believe how they were so happy to spend time and effort to send you endless amounts printed materials citing of the reasons why they couldn’t send you the record for slightly less than $42.50.

    “I hereby inform you under powers entrusted to me under Section 476 that Mr. Buttle, Archibald, residing at 412 North Tower, Shangri La Towers, has been invited to assist the Ministry of Information with certain inquiries and that he is liable to certain financial obligations as specified in Council Order RB-stroke-C-Z-stroke-nine-O-seven-stroke-X.

    That is your receipt for your husband. Thank you. (He takes back his pen.) And this is my receipt for your receipt.”

  • By Lisa, November 25, 2008 @ 12:39 am

    It is funny, not ha ha ha funny, to see other people encounter this problem. It is very important to have your own medical records these days, more than people in general know.

    If I am hospitalized I go to the facility and get my records the day I leave (if possible). When I have an MRI or CT, I ask the technician to run my a copy on CD while I am there. I put my fax number on all labwork slips, but usually have to jump through hoops to get the results even though the facility doesn’t know it is my own fax number and not the doctors. Eight out of 10 times the results are not sent. I imagine that it happens regularly and people just don’t know that the results weren’t sent. Crazy stuff.

  • By Fat Doctor, November 27, 2008 @ 12:01 am

    This is so true. I asked a nurse if she could just give the patient a copy of his labs to take to his PCP. HIPAA no-no, I was told. The request had to go through medical records. Disgusted, I printed out a copy and handed it to the patient, right in front of the nurse. HIPAA be damned!

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