You receive a letter from your doctor’s office saying the practice is closing. Or maybe the practice no longer takes your insurance. Either way, you have to find another doctor.
It may not be one of the first things you think about, but it’s important to know that your medical records don’t automatically follow you to the next doctor. You have to request copies – and that could come with a hefty price tag. Many offices charge for copying those records, and if you have been with a doctor for more than a couple of decades, the costs can add up.
According to Consumer Reports, federal law (and laws in most states) allows doctors to charge for photocopying. The Health Insurance Portability and Accountability Act allows all providers covered by it to charge a “reasonable, cost-based fee” for making protected health information available to a patient or her representatives.
In North Carolina, doctors can charge 75 cents per page for pages 1-25 pages; 50 cents per page for pages 26-100; and 25 cents per page for pages 101 plus. The minimum charge is $10, but that amount can quickly balloon.
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Still, Franklin Walker, director of rural health initiatives for the North Carolina Medical Society, says go for broke.
“I want everything,” he says. “If you have been seen there for 10 years, you’ve got history…. Any provider would want to see the historical record. You need to get the whole thing.”
As North Carolina physicians transition to Electronic Health Records, all of this should become much easier. But we’re not there yet. Walker says a large number of the state’s health providers are still taking patient notes with old fashioned paper and pen.
Track your own history
One thing patients can do is become more diligent about documenting and managing their own health history.
For starters, Dr. Orly Avitzur, medical adviser and a medical editor at Consumer Reports, encourages patients to keep an updated list of medications with dosages handy for all their doctors’ visits. She likes storing the information on an index card. Avitzur, a neurologist, has a 98-year-old patient who maintains an updated medication list. “If he can do it, anyone can do it,” she says.
A list of surgeries is also helpful. The list should include the dates of the surgeries as well.
Before visits to the doctor, Walker suggests that you prepare an index card with organized questions and thoughts about your medical concerns. Be prepared to take notes during the exam. (This is also a good way to make sure you are not distracted by the changing environment in an exam room. Now, a doctor may be peering over a laptop as he addresses you instead of talking and then scribbling notes on a chart.)
And if you are referred to a specialist, ask that office to send your test results to your primary care physician. This way, you can make your health record as comprehensive as possible.
Acquire records as you go
Avitzur urges people to acquire their own copies of records, asking at each visit for the doctor’s report, copies of tests, etc.
“I recommend that patients create their own three-ring binder or electronic equivalent by scanning those documents after they see doctors or are admitted to a hospital,” she says.
The binder should be divided into sections including surgeries, test results and doctor’s notes. You want to make it as comprehensive as you can, she explains.
In addition to the doctor’s notes, Walker requests a copy of his scans. Walker says that normally means he returns to the doctor’s office later in the day to get his results loaded on a flash drive or CD. He wants the scan along with the radiologist’s reading of the scan.
“You have to train yourself not to just leave with the bill or the insurance slip, but with the actual record,” Walker says.
The bottom line is that patients need to be engaged in their own health care to get the best results. Optimum health care means good, two-way communication, Avitzur says.
When requesting records
Dr. Orly Avitzur, medical adviser and editor at Consumer Reports, recommends acquiring:
▪ Copies of all test results, including labs, imaging, pathology
▪ Hospital discharge summaries
▪ List of medications and allergies
▪ Most recent office visits from PCP
▪ Specialist consultations
▪ Operative reports