You can request the medical and billing records held about you by most U.S. health care providers and health plans under HIPAA, then compare them with your own records and insurance statements. If you find something wrong, ask the organization that maintains it to amend the record. An unfamiliar charge or entry is a reason to investigate—not, by itself, proof of fraud.
What records can you request?
HIPAA generally gives you access to protected health information in a covered entity’s designated record sets. That can include clinical records as well as billing, payment, claims, enrollment, and insurance records. The right can apply to paper and electronic records, not just what appears in a patient portal or a provider’s electronic health record. See the HHS explanation of records covered by the access right and its guidance on paper and electronic records.
The right does not cover every internal business record, and an organization generally does not have to create new information or analyses for you. Separately maintained psychotherapy notes are among the limited exceptions. The right belongs to the individual or an authorized personal representative, subject to HIPAA rules and exceptions. HHS summarizes these limits in Your Medical Records.
How to request your records
- Identify each record holder. Make a list of the providers, hospitals or other facilities, pharmacies, laboratories, and health plans that may have relevant information. A provider’s records and an insurer’s claims or payment records are separate requests.
- Specify what you need. Name the record categories—for example, visit notes, medication or procedure records, billing statements, or claims—and give a date range or identify a particular encounter. This helps focus the request without limiting your right to covered records you may need later.
- Choose a delivery format. State whether you want paper or an electronic copy and how you would like to receive it. HHS says the entity should provide the requested form and format when readily producible; if not, it should work with you on a readable alternative. See HHS guidance on readable formats.
- Use the organization’s request process. Ask its medical-records or health-information-management office how to submit an access request; for an insurer, contact its member-services or records department. Follow any identity-verification instructions and keep a copy of what you send.
- Track the request and response. Record when and how you submitted it, save delivery confirmation and correspondence, and note any fee estimate or promised completion date.
How long can the request take, and what can it cost?
Under federal HIPAA access rules, a covered entity must act on a request within 30 calendar days. It may take one additional 30-day period only if it gives you written notice within the first 30 days explaining the delay and stating when it expects to complete the request. These are federal deadlines described by HHS.
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Reasonable copying and mailing costs may apply. An unpaid medical bill is not a valid reason to deny access: as HHS puts it, “You can’t be denied access for not paying your medical bill.” If an organization refuses or says it cannot locate records, ask for the reason in writing. The applicable exception and any review options depend on the reason for denial; HHS outlines the access process and limits in Your Medical Records.
How to review the records for mistakes or suspicious activity
Compare the records with appointment reminders, personal notes, pharmacy records, bills, and your insurer’s Explanation of Benefits (EOB). An EOB generally identifies the provider, service date, services, costs, plan payment, and the amount the plan says you may owe, according to the Federal Trade Commission (FTC).
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- Check dates, provider and facility names, diagnoses, treatments, prescriptions, and procedures against what you remember receiving.
- Compare billed services and amounts with provider bills and the EOB. An EOB is an insurance statement, not necessarily a bill; use it to spot claims you do not recognize and ask the plan or provider to explain them.
- Look for unfamiliar providers, prescriptions, medical debt collection, or notices that your insurance benefits have reached their limit. The FTC lists these as possible warning signs of medical identity theft.
- Separate an entry you do not understand from one you can verify is inaccurate. Coding, billing, timing, or identity mismatches can create discrepancies; ask the provider and insurer to investigate before concluding that someone used your identity.
How to ask for a correction
If information is inaccurate or incomplete, request an amendment from the provider or plan that maintains the record. Identify the specific record and entry, explain what is wrong or missing, and include relevant supporting information, such as the record excerpt or a bill. Send the request in writing, keep a copy, and retain proof of delivery. The FTC recommends reporting suspected errors in writing; HHS describes the formal HIPAA amendment process in Your Medical Records.
The organization must respond under the amendment process, but it does not have to adopt the wording you propose. If it denies the request, you can submit a statement of disagreement for inclusion in the record. Follow the organization’s instructions for submitting it and keep a copy for your files.
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What to do if you suspect medical identity theft
Unrecognized care or claims can affect your medical history, insurance benefits, bills, and credit. Work through the organizations whose records may have been affected rather than treating one unfamiliar entry as proof of identity theft.
- Contact the insurer. Report the suspicious claim to the plan’s fraud department and ask it to investigate and explain any effect on your benefits.
- Contact each relevant provider or facility. Request the records connected to the unfamiliar care and report inaccurate information in writing. Ask how the organization will investigate and handle the record while it does so.
- Check credit reports. Look for medical billing or collection entries you do not recognize and dispute errors with the relevant parties.
- Use the FTC’s recovery resources. The FTC recommends IdentityTheft.gov for a personal recovery plan. Its guidance on medical identity theft also directs complaints about company or provider misuse or privacy practices to ReportFraud.ftc.gov.
- Keep a case file. Maintain a timeline of calls and submissions, copies of requests and responses, and the names or departments you contacted. Retain documents needed for a dispute; shred sensitive medical papers before discarding them.
When an accounting of disclosures may help
You can ask for an accounting of certain disclosures of your health information, but it is not a complete log of every time someone viewed or used a record. HIPAA excludes categories including many disclosures for treatment, payment, and health care operations. HHS says the accounting period can cover up to six years; see its Summary of the HIPAA Privacy Rule. This request is distinct from asking for the records themselves.
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Federal rights and state procedures
This guide describes federal HIPAA guidance. State law may provide additional rights or different procedures, which are not covered here. If the federal access process does not resolve a denial or dispute, check the relevant state rules or seek qualified legal assistance for advice about your situation.
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