Tooth & Nail: When the provider refuses to release records until medical bills are paid

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule provides you an enforceable right to inspect and obtain copies of your records upon request from your healthcare providers and health plans. Under the HIPAA Privacy Rule, they are obligated to provide you with a copy of your records within thirty (30) days from receipt of your request.

But what if you have not settled the outstanding balance of your hospital bills yet? Can your healthcare provider refuse to release your records?

A 63-year-old patient, through YoCierge, requested her medical and billing records from a particular medical facility in New Jersey. However, the facility tagged the request as an incomplete file, as the patient's insurance company had not settled her hospital balance yet. YoCierge confirmed that the facility would not process the request and would not release the records to the patient unless the latter paid her outstanding hospital bills.

The HIPAA Privacy Rule is clear that a provider cannot deny you a copy of your records just because you have not settled your hospital bills. YoCierge then reached out to the facility and explained that it is not allowed to withhold or deny an individual access to her personal health information (PHI) on the grounds that she has not yet paid for the health services she has received. More so, the New Jersey Administrative Code 13:35-6.5 is crystal clear that any licensee is prohibited from refusing the release of medical records just because the patient owes the licensee an unpaid balance.

To bolster our claim, YoCierge sent the facility a HIPAA Violation Notice. Still, the initial attempts remained futile. The facility called us and fumed that the patient's records were still incomplete due to the unpaid hospital balance, so it could not and would not release the records. However, YoCierge promises to protect the patient's rights and interests and to fight tooth and nail to obtain records on the patient's behalf. We reiterated to the facility that its unjust refusal violated HIPAA and the NJ Admin Code. We gave the facility an ultimatum: Release the records, or YoCierge would file a HIPAA Privacy Rule Complaint with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights. After realizing the gravity of its violation, the custodian finally sent the requested records—and they were released free of charge.

Staying true to our mission, YoCierge guarantees clients that record retrieval is our core competency. As YoCierge continues to become a premium provider of record retrieval services, our team ensures that excellence is our normal. YoCierge makes sure that our team understands your needs so that we remain your number one record retrieval partner.