One of the patient rights under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is the right to amend information in your medical records. What this means is that you have a right to ask your doctor to amend your information within your medical records. You also have the same right to ask your health plan to amend your confidential medical information, or protected health information (PHI).
What is a medical record? Your medical record includes your medical and billing records at your doctor's office. Additionally, at Blue Cross Blue Shield (BCBS), it includes the information for payment, claims adjudication and case or medical management records. In both cases these are records that are used to make decisions about your medical care and services.
Most of what you might think is an amendment is taken care under other HIPAA privacy individual rights. For example, amending your PHI does not include telling your doctor's office about your new insurance coverage, updating your phone number and home address or asking for a specific type of communication, such as at your office instead of your home.
What is an amendment? Essentially, an amendment is adding a critical piece of information to your medical record. This does not need to be medical information it may be legal, religious or any other kind of critical information that you want attached to your medical record. For example, if you do not want a specific kind of anesthesia you may ask to have this added to your record. It is not that you are allergic to the anesthesia; you have just decided that you do not want that type used on you during a procedure.
If you do ask for an amendment to your records your doctor may ask you to make this request in writing. If this happens, ask your doctor for the form used by the office. Most doctors and hospitals have a process for this type of request including a request form.
Once you complete the request process, your doctor must act upon your request within 60 days. If he/she agrees with your request you will receive a letter from your doctor confirming this. In the future when your doctor shares your medical record to a specialist for treatment or BCBS for payment they must send your amended PHI so others involved in your care are notified about your amendment.
It is important to remember that your doctor or BCBS does not have to permit your amendment. It may be denied for a variety of reasons, including:
- Your doctor did not create this copy of your PHI or your medical record;
- The PHI you want to amend is not part of your medical record at this doctor's office;
- If your record and the enclosed PHI is not available for review, such as:
- In psychotherapy notes;
- PHI for use in a civil, criminal or administrative proceeding;
- PHI held by a correctional facility;
- The specific PHI is not part of your medical record; and
- Your PHI record is accurate and complete as it is.
If your doctor denies your request for an amendment to your medical records, he/she must send you a denial letter and an explanation of why the request was denied. It must also tell you how you may submit a letter disagreeing with the denial. If you do not want to send a letter disagreeing with the denial, you may send a letter asking that your request for amendment and the doctor's denial be included in any future disclosure of your PHI. If you receive a denial letter, the letter must include information on how to file a complaint to the appropriate federal agency. You can file a complaint within six months of receiving the denial if the denial does not meet any of the reasons outlined above. Also, you must send your complaint to the Secretary of the Department of Health and Human Services within 180 days or you lose your right to complain about this issue.
Remember, if you do not know if your request is an amendment, or a different type of request, ask your doctor's office. They have been following the HIPAA rules for many years and should be able to help you with your questions. If your PHI request is truly critical, tell the doctor and his/her office staff as soon as possible, never mind what it is called.