06/04/2021

Payment from Insurance Companies Requesting Medical Records

We were under the impression Insurance companies were paying a $25.00 per record fee for the procurement of medical records. We're getting requests for anywhere from 25 to 39 charts by various third parties. UHC's third party record procurer stated United Healthcare was adamant about NOT paying any fee for records. We sent W9s and a letter, to date, none of them have paid. Do we HAVE to provide the records?? What penalty can we expect by not responding to their requests?

Insurance Companies do not pay for copies of medical records if they are being requested as part of an audit or if it’s for a specific patient claim. If it is a commercial plan, Managed Care Medicaid plan, or Medicare/Medicare Advantage Plan, the information will have to be provided at no cost. The cost of providing the records to the insurance cannot be passed on to the patient. The only exception to the rule is for some workers compensation or no-fault carriers, where they may reimburse (up to a set amount per NYS law) if medical documentation needs to be provided for any reason.