BS: Fees for transferring medical records

Subject: Fees for transferring medical records
From: Mark Cohen
Date: 15 Mar 02 - 11:03 PM

No, I don't think even I can make this into a musical thread. (There's a challenge for you!) But I know there are some Canadians hanging around here, so I thought I'd ask.

I have a patient whose family recently moved to Hawaii from Quebec. I had her mother sign a release form and sent it to her former doctor, asking for copies of her medical records. Today I received a fax from this doctor, asking me to inform the child's mother that they required a $25 transfer fee before they would send the records. Now, it's always been my practice not to charge when providing copies of records for patients who have moved or changed physicians. That's true for most docs in this community, and has been in the other places I've practiced. It's considered a courtesy. Sometimes doctors will charge a reasonable amount for copying, especially if the record is voluminous (fortunately that's seldom the case in pediatrics), or will just send a summary. But this $25 fee seems excessive to me. Is this common practice in Canada? Or elsewhere? I'm curious.

Aloha,
Mark

Subject: RE: BS: Fees for transferring medical records
From: Amos
Date: 15 Mar 02 - 11:10 PM

First time for everything, Mark -- it is consistent with the constant torwuing of business by managers desperate to trim a little safety off here, a little testing offthere, a little service out of that product -- this is the blinders mentality thast gave us phone-menus from Hell and those hundreds of other irritating "economies" which add up to shitty service and uncaring businesses.

If your patient is forced to pay this fee I would suggest she advise the management of the care facility or clinic that she is going to promote their crassness broadly with recommendations that others stay away in droves.

A

Subject: RE: BS: Fees for transferring medical records
From: Mark Cohen
Date: 15 Mar 02 - 11:27 PM

Amos, I presume TORWU is some kind of acronym, like SNAFU, but I can't figure it out! The old ratchet wind-up?? I think you're right, though. From the letterhead I would guess that this is a solo practitioner rather than a big clinic...which, being a solo practitioner myself, makes it all the more unpleasant. It's not the money I object to so much as the loss of simple courtesy.

Aloha,
Mark

Subject: RE: BS: Fees for transferring medical records
From: Amos
Date: 15 Mar 02 - 11:32 PM

I'm sorry -- I type faster than i can see. :>)

What I meant to type was "TORQUING".

There is an appropriate acronym in Army circles: BOHICA. It is first cousin to SNAFU and FUBAR, and stands for "Bend over--here it comes again!"

A

Subject: RE: BS: Fees for transferring medical records
From: sheila
Date: 15 Mar 02 - 11:43 PM

I've been charged $1 a page for copies of my records in NJ.

Subject: RE: BS: Fees for transferring medical records
From: sophocleese
Date: 15 Mar 02 - 11:54 PM

Mark, I remember seeing a sign in a doctor's office saying that they charged for a transfer of medical records. Tranferring records is not covered by health insurance and its the health insurance that pays a lot of the doctor's bills. I'm not in medicine myself but I can ask a couple of friends if you'd like more info.

Subject: RE: BS: Fees for transferring medical records
From: katlaughing
Date: 16 Mar 02 - 12:09 AM

I've never had to pay for tranferring them, but have sometimes paid a small fee for copying. I usually get copies of them, for myself, then make copies for any new practitioner I may go to, then no worries about transfers and signed releases, etc.

Subject: RE: BS: Fees for transferring medical records
From: Dan Calder
Date: 16 Mar 02 - 09:08 AM

Mark,

Here in Nova Scotia, Canada, my wife was charged $25.00 when she changed doctors within our town, and even within the same building. Her records were carried, literally, across a hall from one office to another. And she is an employee of our health care facility. I figure you got a bargain having to pay the $25.00 to have them sent from Quebec all the way across the pond to Hawaii. It's a good thing the fee doesn't increase with distance.

Dan

Subject: RE: BS: Fees for transferring medical records
From: Amos
Date: 16 Mar 02 - 09:33 AM

Wow -- it's "normal"? It makes me wonder what happened to the old-fashioned business model where the provider paid the overhead and the customer paid for the product, and the notion of doing as much as you could for a customer was a good business principle. Too many MBAs and the curse of Excel spreadsheets upon the land!

A

Subject: RE: BS: Fees for transferring medical records
From: Gypsy
Date: 16 Mar 02 - 11:17 PM

In our office, we have NEVER charged for the transfer of a patients records when the patient has moved. Work comp, attorneys, and insurance companies, we can, and do charge for records. But to charge a patients new doc for records? UGH!

Subject: RE: BS: Fees for transferring medical records
From: 53
Date: 16 Mar 02 - 11:24 PM

One doctor charged me 75.00 to fill out one form, and the hospital wants 89.00 for another. If you're not sick when you go in, you're sure as Hell will be if you come out.

Subject: RE: BS: Fees for transferring medical records
From: Mark Cohen
Date: 16 Mar 02 - 11:43 PM

Just to clarify, the patient was expected to pay the $25, not me. I think it's wrong either way. But Dan's post makes me suspect it may be a standard part of the Canadian system. Amos is right: the world is being overrun by "fees". Much of what used to be overhead expense is now passed directly on to the customer, often with additional mark-up just for the hell of it, to maximize the bottom line. Of course, as a small business owner I should add that many of the businesses who do that are being squeezed in the same way. I remember when the Provincial Museum in Victoria, BC (one of my all-time favorite museums) started charging admission. I heard, probably apocryphally, that most of the fee went to pay for collecting the fees!

Aloha,
Mark

Subject: RE: BS: Fees for transferring medical records
From: Gypsy
Date: 16 Mar 02 - 11:52 PM

THE PATIENT WAS EXPECTED TO PAY? Man, i would be one very unhappy, loud camper in that docs OFFICE, where everyone could hear me!

Subject: RE: BS: Fees for transferring medical records
From: Metchosin
Date: 17 Mar 02 - 12:04 AM

Mark, here in BC the charge varies from nothing to well over a hundred dollars. Medicare pays the doctors here on a negotiated? fee for service basis, but the doctor's office is still a private business and as such, fees for non medical services are left to the discretion of the individual physician.

I put a question mark after negotiated, because the current government of BC is presently in a big labour dispute with the doctors of this province. The government appointed an independant arbitrator to negotiate fee increases with the physicians and said it would abide by the arbitrators award to them and then renegged on their commitment to abide by the arbitrators decision.

Subject: RE: BS: Fees for transferring medical records
From: allie kiwi
Date: 17 Mar 02 - 12:17 AM

I think it must depend on the country. Down here the notes belong to the doctor, and any transfer of these is a courtesy (almost always done, and free of charge). The notes do not belong to the patient, although the information does. That means that if the patient would like copies of their notes they usually pay per page. The notes are sent directly from doctor to doctor, and not usually via the patient concerned.

Copies of notes at a public hospital, however, are available on written request, free of charge to the patient.

Allie

Subject: RE: BS: Fees for transferring medical records
From: Mark Cohen
Date: 17 Mar 02 - 07:05 PM

Metchosin, why am I not surprised by that? We have a similar problem here in Hawaii where one insurer (the Hawaii Blue Cross/Blue Shield affiliate) has about 90% of the business in the state. And we can't even vote them out of office! It's a funny business. Imagine you had, say, an auto repair shop. You fix a customer's car, and hand him a bill for $200. He says to you, "Well, I think I'll pay you $150." And you have to say, "Thank you very much." That's pretty much the situation we're in.

And it gets even better than that. I received a contract last week from a company that's trying to take on a small segment of the health insurance business in the state. It included a paragraph that said, in more or less these words: "Fees are paid to providers [I hate that word!] from XYZ trust fund, and will be paid if funds are available. There is no guarantee that payments will be made." I wonder what they'd say if their customers tried to do the same thing with their premium payments?

I'm sure this will surprise or upset some people who are pissed off at "all you rich doctors"...but you're welcome to take a look at the statements I get from the insurance company. Please understand--I'm not in the poorhouse, and I love what I do. But the CEO and upper management of the insurance companies make a lot more than I do...and they keep raising my patients' premiums higher and higher, leaving more and more people without any insurance at all. Oh, well, back to work!

Aloha,
Mark

Subject: RE: BS: Fees for transferring medical records
From: Gypsy
Date: 18 Mar 02 - 11:29 AM

And the one i would add to Marks statement....the line from Medicare that deems a service "Medically un neccesary" resulting in the refund of the fee to the patient. Now i don't know about anyone else, but if someone solicitates a service from me, i think they should pay for it. After all, that is the docs paycheck.

Subject: RE: BS: Fees for transferring medical records
From: GUEST
Date: 21 Mar 02 - 12:04 AM

seems cheap for all the work involved. pay it.

Subject: RE: BS: Fees for transferring medical records
From: GUEST,GP Family Health Care Practitioner
Date: 21 Mar 02 - 11:06 PM

What would be a fair cost? What would you be willing to pay?

I have a staff and hourly rates and duplicating costs.

Subject: RE: BS: Fees for transferring medical records
From: Mark Cohen
Date: 22 Mar 02 - 01:36 AM

So do I....and I still do it as a courtesy. Of course, I admit that pediatric patients tend to have smaller charts. I might feel differently if I had some of those foot-thick volumes. There's no right answer...I'm mostly seeing this as another erosion of what used to be courtesy and civility.

Aloha,
Mark the old curmudgeon