As we’ve mentioned before, by eliminating the federal limitation on fees for medical records sent via third-party directive, the Ciox Health, LLC v. Azar opinion has turned the spotlight onto the state laws that govern such fees. Of course, it’s best to understand the law of the state where your clients reside, as that law will most often apply to your clients’ requests. But we’re willing to bet that your clients have received medical care elsewhere, and that’s why you should have a general idea of what medical records cost in other states.
To be clear from the get-go, it’s the law of the state that licenses the healthcare facility that governs the fees for medical records requested from that facility. For instance, in Florida, Section 395.3025 applies to hospitals licensed in accordance with Chapter 395 of the Florida Statutes. Likewise, in Kentucky, Section 422.317 applies to hospitals licensed under Chapter 216B of the Kentucky Statutes. And so on, and so forth.
In looking at other states’ laws, we noticed a few things. There’s certainly a trend of using per-page rates. However, in setting such rates, some states do a better job of recognizing the economy-of-scale that is the production of medical records. And despite the widespread use of electronic means to store and send medical records, not many states have recognized the cost-effectiveness of using such means in lieu of printing and mailing paper records.
Out of the 43 states that permit fees to be calculated at per-page rates, 24 of them have a tiered structure, with at least 2 and up to 4 tiers. For example, North Carolina’s per-page rates are $0.75 per page for pages 1 through 25; $0.50 per page for pages 26 through 100; and $0.25 per page for pages in excess of 100. Thus, for 500 pages of medical records, the fee in North Carolina would be at least $156.25, while, in Florida, it would be at least $500.00 (more than triple North Carolina’s fee).
Only a handful of states treat electronic records differently than paper records, and they appear to do so in 1 of 2 ways. One group sets the per-page rates for electronic records at a percentage of the per-page rates for paper records. For instance, in Illinois, Utah and West Virginia, the per-page rate for electronic records is 50% of the per-page rate for paper records.
The other group sets maximum fees for electronic records. For example, Maryland’s maximum fee is $81.63, while South Carolina’s is $160.94. Interestingly, most of the states that set a maximum fee for electronic records do not set a maximum fee for paper records. To us, this speaks volumes about the difference in the costs of producing medical records in paper versus electronic form!
The highest per-page rate permitted by law in any state is $2.50 (congratulations, Rhode Island). To be fair, this rate applies only to pages 1 through 10.
There’s only one state where your client can get her medical records for free – Kentucky. Just be sure that it’s the first copy, and that your client or her agent requests them.
Unfortunately, in comparison to other states’ laws, Florida’s law leaves something to be desired. Refer to our previous post for a more detailed description of Florida law in this regard.