How medical records may affect your health insurance

How medical records may affect your health insurance

Angie’s List member Ron Woods of McCordsville knows firsthand the effects of having an error in a medical record.

He believes his problems may have affected his insurance and says that the issues began while consulting orthopedic surgeon Dr. Dale Snead, who has an overall C rating based on four reviews. “He looked at an X-ray and saw a shadow,” Woods says. “He entered into the records that I had a disease of the lungs.”

However, further exams showed no such shadow, invalidating the first findings, says Woods, who adds that Snead agreed to amend the medical record but never did. “I was getting life insurance when I was informed by the insurer it was still in my records,” he says. “The insurance company refused to insure me, even though I had a near-perfect physical exam from their nurse.”

Snead, a team physician who works for highly rated Methodist Sports Medicine, and practices at locations in Avon, Carmel and Greenwood, didn’t return our requests for comment. Dick Rea, director of communications for the group, declined to discuss Woods’ specific case, citing federal privacy laws. However, he did discuss MSM’s general operating policy. “Methodist Sports Medicine physicians take our patients’ care and their documentation very seriously,” Rea says. “Any concerns identified during a patient visit that is out of a physician's scope of orthopedic expertise would be discussed with the patient and referred to the patient’s primary care physician.”

Woods says the doctor must have amended his medical record at a later date because he has since been able to get life insurance. But, he adds, his experience with Snead has taught him to never assume medical records are accurate. “Don’t be afraid to question your doctor,” Woods says. “They are obliged to…fix their mistakes.”

The U.S. Department of Health and Human Services says HIPAA (the Health Insurance Portability and Accountability Act) grants you “the right to inspect, review and receive a copy of your medical records.” It also addresses a patient’s right to “amend protected health information” if there’s an error. Health experts like Dr. Richard Frankel, a professor at IU School of Medicine who’s studied the patient-doctor relationship for more than 30 years, say there’s a good reason for this rule: It can affect insurance rates or result in unnecessary or potentially dangerous treatments.

A-rated Dr. Walt Beaver of Noblesville Family Physicians says a doctor shouldn’t refuse you access to your records. “It’s [your] legal right,” he says. “If the patient wants their records released, doctors have to do it.”

Angie’s List members who took a recent online poll appear to be paying attention to their records: Almost 80 percent have requested their records, however that poll reveals many don’t act on their knowledge. About one-third of members who found errors chose not to ask the provider to fix them. The poll also highlights some of the related problems members encounter, such as problems getting records transferred to a different health provider and errors in records, including having other patients’ information in their file, mistyped codes, transcription errors or inaccurate diagnoses.

Financial complications like Woods experienced aren’t unusual, says Jim Jensen of highly rated Jensen Insurance Agency in Southport. Under The Affordable Care Act, the HHS says health insurers offering new individual plans “won’t be allowed to turn anybody down or charge them a higher premium because of pregnancy or other health conditions.” However, insurance providers say they can use your medical information to determine rates and eligibility for life, disability and long-term care insurance.

With rising health care costs, Jensen says, insurers are scrutinizing clients more, and he encourages consumers to check their medical records for errors that could bar applicants from coverage or increase premiums. “Insurance companies are wary of conditions that are likely to lead to prolonged, expensive health care,” he says.

The consequences of inaccurate medical records aren’t limited to financial ones, Frankel says: Medical record errors can result in allergic reactions, risky drug interactions and unnecessary treatments. Terry Whitson, assistant commissioner of the Health Care Quality and Regulatory Commission for the Indiana State Department of Health says patients need to watch out for themselves since they often see more than one doctor. “It’s important for records to be accurate so each provider is aware of a patient’s history,” he says.

Medical providers, including highly rated Dr. Risheet Patel, who practices at Olio Road Family Care in Fishers, agrees. “Patients reduce medical errors by making sure what we have recorded in their chart is accurate,” he says, adding HIPAA empowers patients to do this.

Rachel Seeger, an agency spokeswoman with the Office for Civil Rights — a federal agency set up to protect the public — says violators can be fined for not complying with a patient’s written request within 30 days, or within 60 days if the provider gives a written explanation. “It should be relatively simple with every office having its own process, but it involves going to your doctor, making the request, filling out relevant forms and signing it,” Beaver says.

However, getting a copy of your record may not be free. Indiana providers may charge up to $1 per page for the first 10 pages, 50 cents for pages 11 to 50, and 25 cents for pages 51 and beyond per state law. Copies needed within two working days, cost an additional $10, plus the cost of postage. Providers can also charge up to $20 for labor.

If patients notice an error, the HHS says HIPAA gives them the right to have their record “amended,” but it also allows doctors the right to deny a request if they determine the record is “complete and accurate.”

Frankel says he’s heard of patients encountering resistance from their providers when asking for copies of their medical record. “The medical record is the physician’s Mini-Me,” Frankel says. “It’s hard to know why, but if I were a betting person I’d say legal liability is the driver here, as well as a legitimate concern that patients may not [be able] to review the chart and make sense of it.”

For people who find themselves in this position, the ISDH suggests filing a complaint with the Indiana Attorney General Consumer Protection Division. Frankel further says you shouldn’t be afraid to speak up. “Studies have shown that patients who ask questions have better outcomes,” he says. “Reviewing your record provides the opportunity to correct misinformation, prepare for upcoming visits [and] look at progress over time.” Frankel says technological advances make this easier, with online applications, called patient portals, giving consumers direct access to providers, health care systems, test results, records and charts.

Community Health Network and IU Health Connection both offer patients an online solution, allowing them to access health history, test results, medication information, recent clinic and doctors’ visits, and health reminders. Patients can also schedule appointments and request prescription refills online. “The goal is to have informed patients and reduce medical errors,” Patel says. “Patients have accurate, up-to-date information about their records.”

The Indiana Health Information Exchange, formed in 2004, also offers an online network that connects patients, doctors and hospitals and allows information sharing between them. “Indiana has a good Health Information Exchange,” Beaver says. “We’re looking at ways through the HIE to put lab work, imaging, most recent visit information and current medications lists online.” He says many doctors are switching from paper records to electronic ones, 
and a recent study shows the number of Indiana doctors using online medical records increased from 17 percent in 2002 to 58 percent in 2011. Another recent report released by the CDC shows the number grew in 2012 to 74 percent among doctors in Indiana. 

Beaver uses an iPad during patient visits because he believes taking electronic notes, instead of paper ones, cuts down on transcription errors. However, he insists that patients request a printed summary of their visit. “It gives them a current medication list and visit information to keep them and their providers on the same page,” he says. Angie’s List member Pam Meyer of Noblesville appreciates the printed summary of her visits with Beaver. “I usually have questions about unrelated subjects [and] the summary gives me a chance to digest his advice,” says Meyer, adding that it also serves as “a wonderful reference.”

While Angie’s List member Lauren Jackson of Southport has great respect for her rheumatologist, she decided to request a copy of her medical records and then seek a second opinion after receiving some troubling test results. “They were great about it,” says Jackson of Dr. Heather Greist, who is part of highly rated Franciscan Physician Network.

The second rheumatologist agreed with Greist, Jackson says, but adds she still believes reviewing her records and getting a second opinion was the right thing to do: “I most definitely think it’s important to be on top of [your records] and address any concerns you have openly with your provider.”

— Additional reporting by Cynthia Wilson