Unlocking Your Health Records: A Patient's Guide to Accessing Medical Information Under HIPAA

Have you ever felt frustrated trying to get a copy of your own medical records from a doctor or hospital? 

For too long, patients have faced roadblocks when requesting health information that rightfully belongs to them. But with the Health Insurance Portability and Accountability Act (HIPAA), the tide is turning. Patients now have legal rights to access their medical records and health data under HIPAA privacy regulations.

Understanding your rights to your health information under HIPAA is the first step to taking control of your medical care. By learning how to request records, what you're entitled to, and how to overcome access barriers, you can get copies of your full medical history and share records across different healthcare providers. From chronic disease management to moving care to a new doctor, access to your health records is key.

Read on to learn how to take ownership over your health information.

The Core Right of Patient Access to Records Under HIPAA

At its foundation, HIPAA grants patients a core right to view or obtain copies of their medical records and other health information from healthcare providers and health plans. This empowers patients to manage their own care, get second opinions, and have continuity of care when they change doctors.

HIPAA states patients have a right to access their "designated record set" held by a healthcare provider or health plan. This includes medical records and billing records used to make decisions about a patient's care and payment for care. 

Records can be accessed either by inspection or by requesting copies to take with you. They must be provided in the format requested if readily producible, such as paper or electronic copies.

Who Must Provide Record Access Under HIPAA?

Patient medical record access rights under HIPAA apply to records held by:

• Healthcare providers like doctors, hospitals, pharmacies, nursing homes, therapist offices and other facilities.
• Health plans like health insurance companies, Medicare, Medicaid, HMOs, employer-sponsored health plans.
• Healthcare clearinghouses that process health information.
• Business associates contracted to perform work for healthcare providers and health plans.

These are considered "covered entities" and must comply with HIPAA right of access obligations. Business associates in particular are increasingly important, as more healthcare providers outsource things like billing and IT services that involve protected health information.

What Records Can Patients Access Under HIPAA?

Patients have access rights to their full designated record set maintained by covered healthcare entities. This includes:

• Medical records like doctor's notes, lab test results, imaging reports, procedure notes, medication lists, immunization records, allergies.
• Billing and payment records like itemized bills, insurance claims, explanation of benefits statements, records of disclosures of health information.
• Insurance enrollment and eligibility documentation provided to a health plan.
• Claims adjudication and case or medical management record systems maintained by health plans.
• Other records used by covered entities to make healthcare decisions and plan treatment for the patient.

To summarize, here is an overview of the types of records patients can access versus records they can't access:

Records Patients Can Access	Records Patients Can't Access
Medical records (doctor's notes, test results, etc.)	Psychotherapy notes
Billing records	Legal proceedings records
Insurance enrollment records	Certain quality improvement records
Claims management records	Records that may endanger safety if released

Key exceptions where access can be denied include:

• Psychotherapy notes that a mental health professional keeps separately from the medical record. These require specific authorization from the patient for release.
• Information compiled for legal proceedings like malpractice suits.
• Records not used to make health decisions or plan treatment, such as certain quality improvement or peer review records.
• Records where granting access would potentially endanger the patient or others.

Overall however, HIPAA erred on the side of disclosure to give patients access to their health information by default.

How Patients Can Request Medical Records Under HIPAA

To get copies of medical records from healthcare providers or health plans, patients should submit requests in writing. This establishes a paper trail and gives the covered entity official notice of the access request. 

Under HIPAA, requests do not have to include reasons or justification for wanting records.

Write a letter or use a medical records release authorization form addressing it to the specific hospital, doctor's office, or plan. Provide:

• Full name, birthdate, phone number, and if possible, medical record number
• Date(s) of treatment or services to help locate the specific records sought
• Whether you want to inspect the records onsite or get copies sent to you
• Preferred format for copies like paper, electronic, flash drive, CD, etc.
• Where you want copies mailed or contact info to deliver electronic copies
• If requesting billing records, specify whether you want just itemized bills or full claim/payment documentation

HIPAA permits reasonable fees to provide records based on the labor effort and supply costs involved. But records should still be provided even if the covered entity expects payment to be a challenge. Healthcare providers cannot make access contingent on paying fees.

Timelines for Providing Requested Records Under HIPAA

Once a covered entity receives a records request from a patient, they must respond within 30 days under HIPAA. 

Records should be provided in the specific format and manner requested.

If unable to comply in the 30-day window, the covered entity can get a one-time 30-day extension. But they must explain the reasons for delay to the patient in writing within the initial 30 days.

Reasons could include requiring extra time to retrieve older paper records from an offsite location. But covered entities are discouraged from unreasonable measures that obstruct timely access.

Potential Penalties for Violating Patient Access Rights

Under HIPAA, healthcare providers and health plans can face significant penalties for failing to comply with patient access rights:

• Potential civil monetary penalties from the Department of Health and Human Services (DHHS) Office for Civil Rights, which enforces HIPAA.
• Corrective action plans, detailed auditing, or increased monitoring requirements imposed by regulators.
• Reputational harm and loss of patient trust for access barriers. Patients may exercise their rights and switch providers.

Tips for Patients in Getting Medical Records from Healthcare Providers

Don't be afraid to assert your HIPAA rights to medical records a healthcare provider holds, but approach the process cooperatively. With more patients accessing information, many providers are still adapting release procedures. 

Try these tips for smoother record requests:

• Ask to have records released to yourself or another medical provider to aid continued care. Avoid directing records solely to attorneys if possible, as legal requests tend to get extra scrutiny.
• Clarify the specific records needed if a provider seems reluctant to release the entire designated record set. Start with recent or particularly relevant records.
• Offer to bring portable media like a USB thumb drive for electronic fulfillment at the point of care rather than offsite record sharing.
• Ask for cell phone photo copies of paper file contents if immediate inspection access seems problematic. But don't photograph sensitive data like medication dosage charts.
• Escalate respectfully up the office management chain if front desk staff seem unclear on release requirements or create barriers.
• If providers cite HIPAA privacy as a record release limitation, politely but firmly press them on your record access rights under the same laws.
• For denials based on safety risks, request the provider specify the rationale in writing for documentation. Report unreasonable denials.

Conclusion

HIPAA grants patients important rights to access their health records and information. But the law alone is not enough. 

Patients must proactively request records, persist through obstacles, and report violations of their access rights. Only through exercising the HIPAA access right will patients gain full control over their medical care and treatment choices.

For medical practices, having efficient systems and technology in place is key to smoothly providing patients access to their records when requested. With solutions like Calysta EMR, practices can have an all-in-one platform that enables HIPAA compliance, easy medical records management, and seamless patient engagement.

Designed by veterans in the med spa industry, Calysta EMR provides exactly what a practice needs to run effectively and efficiently. Features like automatic backups, practice scheduling, digital consents, online patient booking, text messaging, and touchless payments give providers simple workflows for managing patient records access. 

And with premade aesthetic note templates, e-prescription, telehealth, and chart sign offs, Calysta optimizes clinical documentation and care delivery while remaining completely HIPAA compliant.