Can you sue your doctor for theft of medical benefits?

My husband had some work done by an oral surgeon. The doctor said he would only charge whatever my husband’s insurance paid. He never did send us a bill. Later on, my husband tried to obtain a copy of his medical file from this doctor (my spouse has long-standing medical problems and wanted to get copies of all of his medical records). However, the oral surgeon was the only doctor to refuse to release the records. We’ve now discovered that the oral surgeon billed my husband’s insurance company for services that were never performed (i.e. for teeth that he never extracted and for bone grafts that were never performed).

Asked on August 11, 2013 under Insurance Law, Pennsylvania

Answers:

Robert Slim / Robert C. Slim - Attorney at Law

Answered 7 years ago | Contributor

You have an absolute right to obtain a copy of your medical records upon request.  However, the Texas Board rules provide that a physician may charge a fee for copying and shipping the records.  The fee cannot exceed the "actual cost" of copying the records, and is capped at $25 for the first 20 pages, and 50 cents per page thereafter.  The phsician may not charge a fee if the request is made from healthcare provider in connection with your medical treatment or if the records are being requested for a social security disability claim.


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