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Should you have to pay extra to get a copy of your x-ray records, after you already paid for them?

Posted by Julia M on 1/25/05 at 20:50 (167931)

Just wanted to give an update on my situation. In a previous thread (reprinted below) I explained that the podiatrist I went to didn't take a history or examine my feet, but did want to withdraw fluid from the bursa that he explained had formed underneath my heel spurs (which he found by taking x-rays). I looked everywhere to find out more about this treatment and I haven't found it named ANYWHERE (and Dr. Wander from this site has never used it). I also contacted my general practioner and she recommended that I get my films from this guy and go someplace else. She wants me to see an orthopedist, but I'm try to find another (better) podiatrist. I'm also going to see a naprapath to work on my calf muscles and hamstrings.

When I tried to get my films from the bad doctor, the office told me that I would have to pay $30 to get them, because they would have to make a copy. I was pretty annoyed by this, because I'd already paid for them once. I looked up information on getting medical records and the HIPAA guidelines say that doctors CAN impose a reasonable charge for copying records when a patient requests them. My general practioner thought this was very strange; her office certainly doesn't charge clients for that, and she's never had to pay such a fee herself.

Has anyone else had to pay more money to get a copy of their x-ray films? If so, how much did you have to pay???

I'm really frustrated, because I just found out that this doctor received the American Podiatric Medical Association's Distinguished Service Citation in 2002, served as President of the Podiatric Medical Association for my state, and was the Senior Delegate to the American Podiatric Medical Association from my state. So why didn't he even examine my foot or take a detailed history???

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I've started having heel pain in one foot and my doctor suspected plantar fascitis. She referred me to a podiatrist. The podiatrist did not take a history or examine my feet but did take X-rays, which showed that I have heel spurs on both feet (only one is causing pain). The podiatrist said that heel spurs can cause a bursitis to develop, and that the cause of the pain in the morning is that fluid around or in the bursitis has redistributed itself. He then wanted to use a needle to drain fluid out of the bursitis to reduce the pain. Is this a common treatment? I've heard of cortisone injections, but not withdrawal of fluid. I haven't seen this method listed as a treatment on any plantar fascitis or heel spur site. I said that I would prefer to go with a more conservative treatment. The podiatrist then taped my foot and sent me home with a prescription for an NSAID. He suggested that I come back to be fitted for orthotics when my pain has reduced by 50%.

I'm frustrated because I have very mild pain that only flares up when I run. Once I stopped running on my general physician's suggestion, most of the pain went away. So what I'm trying primarily to do is find out how I can protect my feet going forward, and what kinds of activity I should and shouldn't be doing.

Has anyone had this treatment (withdrawal of fluid by needle) suggested to them?

Reply to Message # 167469

Re: Withdrawal of fluid from bursitis as treatment?
Posted by Tina H on 1/18/05 at 13:34
Julia, I'm hoping one of the doctors will answer this soon, but I can tell you that in the 6months I've been visiting this site almost daily, it's the first time I've heard of withdrawling fluid for treating pf????

Reply to Message # 167473

Re: Withdrawal of fluid from bursitis as treatment?
Posted by Julia M on 1/19/05 at 08:09
Yeah, I haven't seen anything about it either, so I'm wondering, can I trust my podiatrist? Part of me even wonders if it was a cortisone shot that he wanted to give, but then why would he describe it as a withdrawal of fluid? Have any podiatrists or doctors on these boards heard of this?

Reply to Message # 167519

Re: Withdrawal of fluid from bursitis as treatment?
Posted by Dr. David S. Wander on 1/20/05 at 07:24
First, it disturbs me that you said that the doctor never examined your feet or performed a history. I have a hard time with this, and if it's true I would not return to that doctor. The history is at least as important as the exam, if neither was performed get out of that office. Secondly, it is very well documented that plantar heel spurs rarely, if ever actually cause any pain, since the 'spur' is not a small sharp point but is actually a shelf of bone. Third, there have been many cadaver studies that have disputed that a 'bursa' exists below the heel. What does exist are fat chambers that are normal and should not be disturbed. This fat is often atrophied if multiple cortisone injections are given, that's one reason injections should be limited. In 20 years of practice, treating a lot of heel pain, I've NEVER removed fluid from a bursa below someone's heel, and I've ALWAYS performed a history and examination as I'm sure every other doctor on this site. My recommendation would be to find another doctor that will be more thorough and more mainstream.

Reply to Message # 167584

Re: Withdrawal of fluid from bursitis as treatment?
Posted by Julia M on 1/20/05 at 10:19
Thanks, Dr. Wander. I really appreciate your perspective on this.

The only history that the doctor took was a very general history on the forms I had to fill out before I saw the doctor. But this history was the standard questions about my general health, not my foot health. I did list the kinds of physical activity I'm doing on that form (running, walking, strength training), but there was no information about how often, how much, and especially, how the pain was related to exercise. I also brought in several pairs of shoes for the podiatrist to look at, since my regular doctor had recommended that I do that, and he never looked at them, either.

I expected him to at least feel my heels to locate where the pain was, and he didn't do that either. The only time he really touched my feet was when he was describing this injection that he wanted to do.

Thanks again for your perspective. I really appreciate it!

Re: Should you have to pay extra to get a copy of your x-ray records, after you already paid for them?

Ralph on 1/25/05 at 21:04 (167934)

One way to get around the cost which I think he is taking you to the cleaners on, is to have the films sent directly to another doctor. You could have him send them to your general practioner for that matter and she/he could give them to you or to the next doctor that you plan to see.

I've never had to pay to have films sent to another doctors office, however, you will need to sign a release form. They may drag their feet though. I think its very telling when a doctor does what yours is doing.
I think it's a good thing you are walking away from him.

Re: Should you have to pay extra to get a copy of your x-ray records, after you already paid for them?

Ralph on 1/25/05 at 21:11 (167935)

Maybe I should have said have another doctor request them to his office via a signed release form from you. They might give you a harder time if you request them to be sent, by that I mean real slow moving, but if the other doctors office requests them he should respond to that request quickly.

Re: Should you have to pay extra to get a copy of your x-ray records, after you already paid for them?

Dr.Wishnie on 1/25/05 at 21:15 (167936)

This is an ongoing problem. The patient pays for taking and interpreting the x-rays not to own the x-rays. Due to attorneys, doctors need to keep x-rays on hand for 7-10 years. This is like your tax records. Doctors are reluctant to give you the originals because in case of a law suit they will not have the records. So, the doctors need to make a copy. Copying the x-rays are not cheap because the film is expensive. I do understand the patients point of view. So, what I do is offer them a digital photo of the x-rays which is just as good as the originals. There is no charge for these photos. I hope this explains it.

Re: Is $15 per film reasonable? Can a photocopy be made of the films?

Julia M on 1/25/05 at 21:24 (167939)

Thanks, Ralph and Dr. Wishnie. This doctor certainly never offered to make me a digital copy! I imagine that x-ray film is indeed expensive. This doctor is charging me $15 each for two slides, so $30 total. Does this seem reasonable? Also, is it possible to make a photocopy of an X-ray slide?

I'm reluctant to ask my general practitioner to request the slides because technically they have up to 60 days to do this, and because this doctor has been completely unhelpful in every other way, I'm not expecting much. I'd like to get seen by someone else sooner rather than later.

One option is to simply have the new doctor take new slides, as I'll have to pay a co-payment for any new doctor's visit anyway, so my insurance should cover the cost of the new films. I'd just prefer to avoid x-raying my feet any more than is necessary.

Re: Is $15 per film reasonable? Can a photocopy be made of the films?

Dr. Z on 1/25/05 at 22:00 (167946)

Hi

In my office I would just have the patient sign a release and request to return the x-ray.after they are done with them In 25 years I have never had a request by an insurance company to review my x-rays. Now if there was surgery done I do copy them but I never charge the patient. Obviously they are unhappy so why add oil to the fire. It does cost money to duplicate x-ray films about five dolars per sheet. So in your case if there is three sheet of filme that were be $15

Re: Should you have to pay extra to get a copy of your x-ray records, after you already paid for them?

Dr. Z on 1/25/05 at 22:01 (167947)

Ralph,
I agree. Have the next treating doctor request the x-rays to be send directly to him. This is no big deal. Doctor one should just give the x-rays to the patient with a signed release.

Re: Is $15 per film reasonable? Can a photocopy be made of the films?

Dr. David S. Wander on 1/26/05 at 07:02 (167961)

Julia,
X-rays, just like your records are a permanent part of the office records. I agree with Dr. Wishnie. I do not give out original x-ray films, just like I do not give out original medical records. Attorneys and malpractice insurance companies constantly advise against giving out original x-rays and original records, even with a signed release. I will make copies of the films for the patient often at no charge or a nominal charge if I incur an expense. As per Dr. Wishnie's comments, the patient has paid for the service of having the x-rays taken and interpreted, and does not 'own' the original films. The patient ALWAYS has the rights to copies of his/her complete records, including any x-rays and the doctor does have a right to charge a 'reasonable' fee. In some states that fee is actually set by the state. It may be easier to pay the $30 and get out of that office ASAP or just have the new doctor take new films. I hope this information helps.

Re: He's charging $15 per sheet.

Julia M on 1/26/05 at 08:34 (167966)

Thanks, Dr. Z. This doctor is charging $15 dollars per sheet, and since I had two sheets, it adds up to $30. This seems a little high to me, but as one of the other doctors mentioned, it's possible that this cost is set by the state, so who knows? At any rate, although the percentage mark-up sounds high (300%), the actual amount is fairly low ($20). Although I'd much rather put that money toward a pair of arch supports or a night splint, at this point I just want to get rid of this guy.

I really appreciate your input on this.

Re: Is $15 per film reasonable? Can a photocopy be made of the films?

Ralph on 1/26/05 at 08:38 (167967)

I forgot to mention that there have been times when new x-ray were taken at the new doctors office inspite of me having the old ones. Some doctors prefer to take their own pictures and you know sometimes the new ones are better than the others. Like you say you may be just smarter to pay for new ones, but I understand what you mean about having too many xrays.

Re: Thanks for all the replies here.

Julia M on 1/26/05 at 08:45 (167968)

Thanks Dr. Wander, the information does help. So far every doctor I've talked to has said that if they charge a fee at all, it's a nominal one, or that they provide the patient with a copy. This confirms to me that this doctor is behaving within his rights but may still be trying to take advantage of the situation.

I agree that it may just be easier to pay the $30 and get out of the office entirely. Although it means another long drive to get to the office as well as the cost of the x-rays, I think I may take that option because I don't want this doctor's poor treatment of me to delay my own treatment any longer.

I really really appreciate the replies of all the doctors (and patients) on this board. After dealing with this one difficult doctor, the support I have received here has convinced me that he is one bad apple, but that most podiatrists are a very good bunch.

Thanks again.

Julia

Re: Thanks for all the replies here.

Tina H on 1/26/05 at 15:05 (167995)

Julia, Last couple of times I had xrays, I was given a copy at no charge on the day the x-rays were taken with a note saying not to loose the copies because if I required another set I would be charged. The originals were forwarded to the Doctor's office. These were taken at a hospital, both times. Last time there were about 12 involved because they were both feet, and knees several angles. Since we've moved alot, it's been useful to have these copies.

Re: Should you have to pay extra to get a copy of your x-ray records, after you already paid for them?

Linda V on 1/27/05 at 13:34 (168043)

It is against the law in NH to make copies of mammogram xrays...so when I need to to have mine reviewed by another facility...I hand carry the originals, and the reviewing facility mails them back to the original owner. There is no charge.

Re: I paid the $30 and got an apology.

Julia M on 1/27/05 at 15:33 (168053)

Thanks again, everyone, for your input.

I went and got the copies today and paid the $30. The doctor asked to speak with me and asked me why I was choosing another doctor. I told him very politely 'Because you didn't physically examine my foot, and because you didn't ask me what level of pain I was in before recommending a treatment.'

He said, 'Well, to you, your pain is unique, because it's the first time you've had it, but I see five to six patients a day with this problem. But I'm sorry if I offended you.'

I said, 'I appreciate your apology.' And then he left the room. I paid for my copies, got a reciept, and left.

To me, this confirmed my impression that this doctor felt that it was a waste of time to physically examine my feet, because I was just like every other PF case he sees every day. I didn't bring up the weird bursa fluid withdrawal treatment specifically because, who knows, it could be a legitimate treatment. It just wasn't appropriate for my level of pain. I appreciate his politeness and his apology, but I don't want someone like that making orthoses for me. Who knows what else he thinks is a waste of time? So, hooray, I have my films and can go somewhere else.

Thanks again to everyone for all your input.

Re: I paid the $30 and got an apology.

Dorothy on 1/28/05 at 00:19 (168076)

Julia M - I'm not a doctor. I've been following your situation here and may I say that I am very proud of you for how you conducted this. It is so completely wrong for a doctor or any professional to whom one goes for help to be so empty of intelligence and curiosity and diagnostic skill and 'people skills' that he/she no longer sees the individual, no longer does even the most fundamental aspects of his/her job - a doctor who actually believes he has seen it all and knows it all. Disgusting and disturbing. But to YOU: well done! Give any thought to registering a complaint against this doctor?

Re: I paid the $30 and got an apology. Dorothy

Pat on 1/28/05 at 14:23 (168102)

I think you did the right thing - sometimes doctors only worry after their clients start leaving them. A few years ago I went to an Orthopedic Surgeon because I was considering arthroscopic surgery. After waiting over an hour in the waiting room I went to ask a nurse how much longer did she think it would be. She looked at me and pointed to the doctor and said 'Ask him'. I went over to ask him and he just looked at me and walked away so I got up and walked out. His staff called me the day after asking if I wanted to 'reschedule'. I told them that my knee leg could fall off before I had the doctor operate on me. I told them he needs to realize where his bread and butter is from and to ignore someone who is asking a simple question is ignorant. Well, about a week later I got an apology in the mail from him and another followup call. I told them the same thing. Now I realize that doctors are human and run behind schedule and things happen but why can't someone in their office open their mouth and tell everyone what is going on. We have lives too! But they'd rather have you sit there and steam a little. I also learned that if the office staff isn't friendly and helpful then I don't need to go there either because they tell alot about the working environment.

Re: I paid the $30 and got an apology. Dorothy

Dorothy on 1/28/05 at 15:22 (168105)

Hear! Hear! Courtesy and communication go a long way to smooth an otherwise difficult situation.

Re: Registering a complaint/writing a letter

Julia M on 1/28/05 at 20:46 (168112)

Thanks for your support, Pat and Dorothy. I think I want to wait until I know exactly what is going on with my foot to think about a complaint. I also wanted to give him a chance first to change his ways. Besides, he was on the board of podiatrists in my state for years, apparently, so I don't know if anyone would listen to me anyway.

I forgot to mention that my mom had a very good suggestion which I followed when I went back for my films. I wrote a letter to the doctor explaining why I was leaving his practice. I wanted him to know and give him a chance to do things a little differently with the next patient. I told him that I was surprised that he did not perform a physical exam or take a detailed history, and that my general practictioner was also very surprised to hear this. I also told him that my general practitioner was surprised that he charges for his films and surprised by the amount. In fact, she was totally floored when I told her about this guy, and she apologized for sending me to him. He came very highly recommened to her.

At any rate, this lets the podiatrist know his policy with regard to the films is perhaps not in line with what lots of other doctors are doing, without saying, 'Hey, you're charging too much!', because as one of the doctors here pointed out, I have no way of knowing what his real costs are for making the copies. It also lets him know that he may have lost a stream of revenue from patients referred by my GP.

I'm trying to do the best thing for this guy and for his future patients. It's so easy to get angry and want to have revenge for this kind of treatment: I've imagined throwing a tantrum, screaming and yelling, even picketing his office. But what good will that ultimately do for him or for his patients? He'd just write me off as a lunatic (and rightly so). I hope this makes him reconsider treating all patients with heel pain/heel spurs the same way. ESPECIALLY because I just found out that I might not have PF at all! I think I'll start a new thread to discuss that, though.