Key points
- The federal health privacy rule lets you get a copy of your own records from a provider or a health plan.
- The provider must act on your request within 30 days, with one extension of up to 30 more days if it explains the delay in writing. It may charge only a reasonable, cost-based fee.
- Ask each place that treated you, in writing, and keep proof of when you asked.
- Your appeal deadline keeps running while you wait for records, so ask early.
Your medical records are the proof behind an appeal: what you were diagnosed with, what was tried, what the tests showed and what your doctor recommends. You have a right to a copy of your own records. Ask each provider in writing, say you need them for an insurance appeal, and send the request early, because your appeal deadline keeps running while you wait.
What this means
The federal health privacy rule, the Health Insurance Portability and Accountability Act (HIPAA), gives you a right to see and get a copy of your own health information from a provider or a health plan. The provider must act on your request within 30 days. It may extend that once, by up to 30 more days, if it explains the delay to you in writing. It may charge only a reasonable, cost-based fee for copies. For a provider, the records you can ask for include medical and billing records.
This is a different request from the one you send your insurer. Your insurer’s claim file shows what the plan did. Your provider’s records show your care. See how to request your claim file for the plan’s side.
Some state laws set faster times than 30 days. Your provider’s office can tell you its own process.
What to do
- List who holds records (your step). Write down every doctor, hospital, clinic, lab and imaging center involved in the care that was denied, and in the care that led up to it. Each may hold different records.
- Decide what you need. For an appeal, ask for: visit and progress notes, test, laboratory and imaging results and reports, medication lists, treatment plans, referral letters, and any letters or forms exchanged with your health plan. Name the dates and the condition so the office knows what to pull.
- Check the office’s process. Many offices have their own request form or a patient portal. Ask the front desk or the records department how to start. If there is a form, fill it in and also send your own written request.
- Write the request. Use the medical records request letter or the records request builder. Say you are asking under your right of access to your own health information, that you need the records for an insurance appeal, and how you want them sent.
- Send it so you can prove it. Use certified mail with a return receipt, a fax with a confirmation page, the provider’s portal with a screenshot, or hand it in and ask for a dated receipt. Do not guess a fax number or address.
- Mark day 30 on your calendar. If nothing has come, call the records department, ask for the status, and write down the date, the person’s name and any reference number. Then follow up in writing.
- Ask your doctor for a letter at the same time (your doctor’s step). The records show the facts. The letter explains them. See how to ask your doctor for a letter.
- Read what arrives. Check that dates, diagnoses and treatments are right. If something is wrong or missing, tell your doctor’s office and ask how it can be corrected.
What to send with your appeal
Not every page helps. Pick the records that answer the plan’s reason for denying. If the plan said a treatment was not needed, send the notes and results that show your condition and what was tried before. If it said you did not try something first, send the records of what you did try. The evidence checklist builder can help you match records to reasons.
What the office may say, and what to say back
“It takes six to eight weeks.” Ask how that fits with the rule: the office must act on your request within 30 days, with one extension of up to 30 more days only if it explains the delay in writing. Ask for the explanation in writing.
“We only send records to another provider.” You have a right to a copy of your own records. Ask the office what its process is for patient requests, and ask for it in writing.
“There is a fee.” Only a reasonable, cost-based fee is allowed. Ask what the fee covers and what it will be before the office copies the records.
The rule
A health plan or provider must act on an individual’s request for their own records within 30 days, with one extension of up to 30 more days if it explains the delay in writing, and may charge only a reasonable, cost-based fee. See section 164.524 of Title 45 of the Code of Federal Regulations (CFR): 45 CFR 164.524.
Watch for
- Not “30 days guaranteed”. The rule is 30 days plus one possible extension of 30 days with a written explanation. Some state laws are faster.
- Many providers. A hospital, a specialist’s office and a lab may each keep their own records. Ask each one.
- Your deadline. The plan must give you at least 180 days after you receive the denial notice to appeal, and your plan may allow more. Check the date on your notice, which controls. If the records are late, file the appeal and say you have asked for them, naming the date.
- Records from your plan. You can also ask your health plan for its records about you, which include claims and case management records. This is the claim file request.
- Billing records. The same rule covers a provider’s billing records. See how to ask for an itemized bill.
What next
- How to ask your doctor for a letter of medical necessity: the letter that explains your records.
- How to ask for an itemized bill and check it: the billing side of your records.
- How to assemble and send an appeal packet: where the records go.