Mistakes in medical records can hike your health insurance premiums
Daniel Workman
Some patients mistakenly believe that they own their medical records. The fact is that medical records belong to the health care provider or facility that prepares them.
With ownership out of your hands, your medical records can be tainted by inaccurate and outdated information. According to the Identity Theft Resource Center, mistakes in your medical records can lead to inappropriate treatment plans that cause fatal drug interactions or allergic reactions. Also, health insurance companies may decline coverage — or charge higher premiums — based on false statements they see in your medical history.
Fortunately, the federal Health Insurance Portability and Accountability Act (HIPAA) and state laws enable you to view a copy of your medical records and fix any errors that you find.
Asking for a copy of your medical records
Submit your request in writing, asking that the health care provider send medical record copies directly to you. In California, providers don’t have to forward medical records to a patient’s insurance company or lawyer, according to the Medical Board of California.
A written request enables you to track your provider’s response time. Generally, HIPAA rules allow up to 30 days from receipt of your request. A stricter California law requires a doctor to provide copies within 15 days.
You may receive your medical records even faster if you follow a provider’s specific procedures. These often include request forms and photocopying fees. Because medical records often are retrieved based on your Social Security number, be sure to include those seven digits in your request.
In California, be aware that your doctor may prepare a detailed summary instead of sending a copy of your entire medical record. You can specify that you want only a summary for certain portions of your medical history.
You also have the right to see copies of specialist reports and lab test results incorporated into your primary doctor’s medical records without asking the specialist or lab that performed the test.
Fixing your medical records
If you notice inaccuracies or missing information, HIPAA empowers you to correct your medical record by adding comments — but not changing or deleting existing text, according to Georgetown University’s Center on Medical Record Rights and Privacy. For example, if you disagree with your doctor’s diagnosis of major depression, you are limited to adding information like a second professional opinion or proof that supports your position.
Some states impose a word limit, so write concisely — the Identity Theft Resource Center recommends a maximum of 250 words.
The provider can agree to update your medical record with your addendum. Otherwise, the provider will explain why your amendment request was refused. You can’t appeal that decision, but you can furnish a brief written explanation of why you disagree. The provider must add that statement to your medical records, and can add his or her own note that disputes your assertions.
Going forward, the provider must include all additions and dispute responses in your medical records when disclosing it to third parties — including health insurance companies.
Correcting your MIB records
Besides health care provider records, insurance companies also check medical data from MIB Group Inc, which tracks medical information previously provided to its member companies. If an insurer sends you a letter explaining that your application was denied, restricted or subject to higher premiums and that MIB was used as an information source, you can ask MIB for a copy of your record.
If you disagree with information on that record, contact MIB and ask for a Request for Reinvestigation Form. Specify what information you disagree with, and then return the completed form to MIB.
MIB will work with the member insurance company to resolve your concerns. If you are dissatisfied with the outcome, submit a statement of dispute that becomes a permanent part of your MIB record.
Enforce your rights
Most states vigorously enforce your rights to review and update personal medical information. For example, if a doctor refuses to release your medical record, you can file a complaint with Medical Board of California. That state agency can force compliance, with penalties as severe as suspension of a practitioner’s medical license.
