Can a doctor withhold test results due to non-payment? My niece took her daughter to a doctor for medical tests. The doctor said the tests indicated a disorder that require therapy. But the doctor won't release the test results until he is paid $500. Can doctors hold test results for payment?
The federal HIPAA law generally gives patients the right to obtain copies of their medical records. I would expect test results to be included. According to the link above: A provider cannot deny you a copy of your records because you have not paid for the services you have received. However, a provider may charge for the reasonable costs for copying and mailing the records. The provider cannot charge you a fee for searching for or retrieving your records. If you think these rules have been violated, you can file a complaint with the federal Office of Civil Rights.
The rule applies to &quot;A covered entity or business associate&quot;, who may not &quot;use or disclose protected health information&quot; except as permitted. The set of covered entities and business associates is pretty large, and certainly covers nurses, also secretaries working for the hospital or insurance company. It is not restricted to the doctor-patient relationship. However, the restriction is not absolute: a patient can consent to the disclosure of such information: but, the consent must be written. This raises an interpretive challenge, in case patient A reveals a medical fact to a friend B who happens to be a medical professional. Person B probably is a &quot;covered entity&quot;, since they are undoubtedly A health care provider who transmits any health information in electronic form in connection with a transaction covered by this subchapter. The information also is &quot;protected&quot;: Protected health information means individually identifiable health information: (1) Except as provided in paragraph (2) of this definition, that is: (i) Transmitted by electronic media; (ii) Maintained in electronic media; or (iii) Transmitted or maintained in any other form or medium. (2) Protected health information excludes individually identifiable health information: (i) In education records covered by the Family Educational Rights and Privacy Act, as amended, 20 U.S.C. 1232g; (ii) In records described at 20 U.S.C. 1232g(a)(4)(B)(iv); (iii) In employment records held by a covered entity in its role as employer; and (iv) Regarding a person who has been deceased for more than 50 years. Para 5 on prohibited uses and disclosures explicitly lists the prohibited disclosures (genetic information for insurance underwriting, sale of PHI), so idle gossip is not explicitly prohibited. It is also not explicitly allowed. But again, the regulation says: may not use or disclose protected health information, except as permitted or required by this subpart Nothing in the rules limits the obligation of a &quot;covered entity&quot;, in terms of how they came to be in possession of PHI. Given the definition of &quot;covered entity&quot;, the fact of being a covered entity is a property does not depend on obtaining information electronically. So without written consent, B who is a covered entity cannot gossip about A's medical status.
The very first thing Bob should do is call his doctor to see if he needs medical treatment. The second thing Bob should do is call his lawyer (solicitor and/or barrister), who will be familiar with the necessary procedure to request an adjournment. In general, court proceedings can be adjourned if the defendant's presence is required but they cannot attend due to ill health or similar involuntary issues. A medical certificate may be required, so Bob may need to contact his doctor to see about getting one. Details about the requirements for a medical certificate are in Section 5C of the Criminal Practice Directions. In particular, 5C.2: If a medical certificate is accepted by the court, this will result in cases (including contested hearings and trials) being adjourned rather than the court issuing a warrant for the defendant’s arrest without bail. Medical certificates will also provide the defendant with sufficient evidence to defend a charge of failure to surrender to bail.
In the US, people are generally allowed to charge arbitrary amounts for services, as long as they do not violate various anti-discrimination laws in doing for. For example it would be illegal to charge people of one race less than they charge people of another race, because of federal and state anti-discrimination laws. Three primary factors govern the legality of a particular form of discrimination. One is the type of interaction, for example "voting rights", "public accommodation", "employment", "housing" – medical treatment would generally fall under "public accommodation". The second is jurisdiction – there can be federal, state, and municipal laws governing a particular kind of discrimination (the lower in the hierarchy you go, the stricter the laws tend to be). Finally there is the "protected class", that is, the basis for discrimination. Protected class is extremely variable, given the preceding two factors. Age discrimination is legal in ways that race discrimination is not. "Has insurance" is not a protected class anywhere, so this does not violate any discrimination laws (per se). There are numerous legal forms of discrimination which are analogous, for example to shop at Costco at all, you have to be a member; there are numerous businesses that offer "member discounts"; some doctors work on a "subscription" basis where they don't treat you unless you are a (paid) service subscriber. The idea that a service has to treat all comers identically is legally incorrect. Co-pay rates are dictated by insurance companies, and can vary depending on the specific insurance carrier that you have. To the extent that there are no specific laws saying otherwise, a service provider is legally entitled to charge less to a person who does not make a claims for coverage by medical insurance – or they could charge more. Indeed, the "without insurance" cost of medical services is typically higher, and the insurance company insists on doctors accepting lower compensation. A "practical" but somewhat risky solution is that if you know that the copay is higher than the street price, you can simply not reveal that you have insurance. However, sometimes an office visit results in a finding that some treatment is needed, and the street price for that treatment may be substantially higher than the insured price. At any rate, contractually-determined co-pays are legal. I should mention a remote possibility for applying anti-discrimination laws, owing to sec. 1557 of ACA. See this article on health care discrimination litigation, where the law enabled "private right of action for disparate impact claims opens the door to class-based claims challenging facially neutral health care policies, treatment decisions, and insurance coverage on the basis that they disproportionately affect members of protected classes". Under this regime, if a policy effectively discriminates on the basis of a protected class, without explicitly mentioning the class, the policy could still be found illegal. If there is a strong enough correlation between race and having health insurance, then "having health insurance" could be found to be a substitute for discrimination on prohibited grounds. There isn't enough case law on this issue, that we can clearly say that such an argument would or would not work.
You have to look at the contract, which is that thing they made you sign before the treatment. The primary rule is that the written contract rules (look for a clause saying that &quot;this is the whole agreement&quot; – there is a legal principle, the 4 corners rule, that precludes verbal statements from determining what the agreement is), and the contract probably has a specific statement about your financial responsibility. They may be contractually limited to certain amounts if you are an &quot;in network&quot; patient (because of their contract with the insurance company), but there is always language saying that if the insurance company doesn't pay (not in-network, or some deductible or other coverage-related issue), their friendly cost estimates are not price commitments. You can refuse to pay and they can take you to court; you can make your argument that they promised to do the work for $120. They will counter-argue that they gave you an estimate of the actual cost based on information that they had available, but you agreed to pay the full amount, insurance-based estimates notwithstanding. You can argue that at no time did they ever tell you what the worst-case scenario price would be, and they can argue that a reasonable person would know that $120 is not the full price for a crown and filling. They can argue on grounds of unjust enrichment that you owe them more money. It is not uncommon for people to misinterpret dental estimates as concrete prices.
You are entitled to at least see, and probably get a copy of, any document you sign. If you insist, they will have to show you or give you a copy. It may well be that they are supposed to give you a copy even if you do not ask. But if you are going to insist, allow a bit of extra time at such appointments. If they describe the document, even in rather general terms, your signature is probably binding, unless they have significantly misrepresented the document. If they tell you it is consent to be treated and it is actually an agreement to purchase a timeshare, that would be fraud and the document would not be valid, but that would be very unlikely. There might be some provision that you do not like, but such agreements are usually fairly standard, and also usually not very negotiable if you want service at that office. Still, it is better practice to at least look over and get a copy of any document you agree to.
To my knowledge there is no actual law requiring a provider to file anything on your behalf. Most do it as a courtesy but if you read the terms of service that you almost certainly agreed to, it will say that YOU are the responsible party. If the insurance company doesn't pay, even if the provider doesn't submit a claim, the responsibility is still yours. There is nothing stopping you from filing your own claim using whatever forms or procedures that they have established. I'll also note that many provider networks have rules that providers must adhere to in order to remain in that network. Some may include language about timely filing of claims but that is in no way universal. These days many providers have taken to billing the patient the full amount immediately and then will issue a refund to you if/when the insurance pays.
Yes in general Generally, almost all western jurisdictions (be they civil law or common law) have some way to get medical records into evidence, be that via subpoenaing, or by discovery requests or court orders. In most cases, the party that brings the suit is also the patient or their legal representative, and they give (or imply) consent to the use of the records. And in cases where the defendant's medical records are required, usually, the defense wants those in too to prove some condition. And then there are cases where the state or their representatives brings the charge. They usually can bring a warrant or court order to obtain the documents. Then there are Medical records that had been made specifically on the behest of the state. Here, the warrant is usually filed to obtain the samples or access to the body to be investigated, the record itself forms the basis for the investigators to proceed - and is not under client-doctor confidentially in the first place. It had been made specifically for the state and it is a state-owned medical record, be they made on request of the executive power (police) with a warrant signed by a judge or on behalf of the judicative after a court order to evaluate capacity (see below). However, medical records can generally only be obtained if the records are relevant to the case at hand and only to the degree necessary: You can't request the medical records about a person's fertility status in a case that discusses damages for his broken arm. As a result, the medical record available in court might be only an extract from the original, with irrelevant passages sealed or redacted. Unlike many people think, it's quite common to get some medical records into court in some way or another: As the basis of injury cases If you have a case of physical injury, the injuries themselves need to be proven in court. This is done generally by getting the medical records - thus they can be subpoenaed by a party, usually the injured party here. Then a medical expert can discuss them, be they a court-appointed one or paid by either of the parties. In this category also fall mandatory reports of certain types of wounds or situations. As such, the treating doctor has to provide a medical report with enumerated types of injuries, like bullet wounds or where child abuse might be the reason. Very necessarily in malpractice cases Malpractice is pretty much injury on steroids: the injuring party made the records and would never want to give them up to the one suing them - if they could. Alice shall remove Appendix. It goes haywire and the day after Charly needs to cut Bob open again. Now Bob sues Alice for malpractice. Bob needs medical records from both Alice, the doctor who botched it, and Charly, who was fixing Alice's error. Generally, both records are subpoena-able to the degree relevant and necessary, and indeed the opposing medical opinions on the operation and records form the very basis of the case for either side. Without the ability to subpoena the - in this case unmodified - records from the injuring doctor, proving - or defending - a case of malpractice would be impossible: the very truth of the allegation should be in the medical records. It's routine in cases around death What is the very last medical record a person can ever get? An autopsy record! That's a very sensitive medical record, but they routinely are used in homicide cases. Oftentimes, the investigators also subpoena the medical records of the victim from their doctors to corroborate the autopsy record, while the defense might subpoena them to try and disprove it. Even in civil cases, like the OJ-Simpson civil damages case, autopsy and medical records from an accompanying criminal case can and will be &quot;pulled&quot; (copied over) from the other trial's docket. Regularly in child protection cases Whenever child protection is on the line, be them protective orders or who a child will live with after the child protection service (whatever its name is) is in on a case, then medical records are often required to bolster one side. Those records could be medical records from quite many doctors, be they physicals or psychological evaluations... Sometimes the medical records required here are only created due to court-ordered medical or psychological evaluation by a doctor. Whenever incompetence defense is called When the lawyer claims temporary incompetence or insanity, courts generally order a psychological evaluation. These medical records are evidence, but usually don't need to be subpoenaed: they have a waiver form to be disclosed to the court almost built-in. Are they available to the public? Medical records are part of truth-finding, but they are also quite sensitive. As a result, most medical records can not be gotten from the court and enter the dockets under seal. Another option is, that they enter the docket partially or even mostly redacted, with passages blackened.