Fee Issues, What to Do…
Kristen M. Lambert, Esq., MSW, LICSW, FASHRM
Vice President, Psychiatric and Professional Liability Risk Management Group

Our Allied World Risk Management team receives calls occasionally on our risk management line about whether a psychiatrist can withhold a patient’s record, particularly if the patient has an outstanding balance for services. First and foremost, it is a difficult situation if your patient owes money for services rendered. You certainly are entitled to receive payment, whether it is a co-pay or your patients are private pay; however, when a patient owes money, it can strain the relationship.

In general, patients are entitled to a copy of their record. Note, however, circumstances may exist in which you might not want to provide the records for a variety of reasons. Further, you may not need to provide the complete record or psychotherapy notes. Without addressing these issues as they are complex and case specific, should you encounter an issue where payment is owed but the patient requests the records, it is important to consult with a risk management professional or attorney to obtain advice. Let’s take a look at a few examples of issues that may arise.

Your Patient Owes Money; Can You Withhold Their Record?

Q: My patient has not paid the bills for my time and now she is requesting her medical record. I do not want to provide it until the bills are paid. Can I?

A: No, it is not advisable to withhold the patient’s record despite the fact that she owes money.

HIPAA specifically indicates that you cannot withhold a patient’s record due to non-payment.1  You can, however, charge a nominal fee to copy and for postage to send the records.2  Some states may have specific amounts that can be charged and it is important to be aware of applicable state regulations.

Your Patient Owes Money; Can You Refuse to See Him Until Payment Is Made?

Q: My patient owes money and I want to stop seeing him until he pays me for my time. Can I?

A: It is recommended that you adhere to the state guidelines concerning doctor-patient relationships and termination. Many states have regulations indicating how much time you must provide a patient before terminating with him. Some circumstances may exist where you might need to terminate immediately, if permitted in your state, but owing money for services does not likely apply. If you find yourself in this situation, it is best to contact your risk management professional or attorney to assist in termination to minimize the risk of a claim for patient abandonment. Strategies can be implemented to minimize the risk of potential for a malpractice claim or board of medicine complaint.

Your Patient Owes Money and Cannot Afford Your Services; Can You Agree to Accept a Lesser Amount or Work Out a Payment Plan?

INSession_Summer2016_BillingSmallQ: My patient owes money, and I do not want to terminate him but would rather try to work out an arrangement with him. Can I?

A: Yes, assuming that the patient is private pay and, to the extent you are accepting insurance, doing so would not violate your agreement with the insurer.

Your Patient Owes Money; Can You Sue Her For Monies Owed?

Q: My patient owes thousands of dollars and has not made assurance that she will pay me for my time. I want to file a small claims court action against her in order to recover monies. Can I?

A: In this circumstance, it is best to consult a local attorney to determine if there are applicable regulations or case law. However, you must always keep patient privacy in mind. If you pursue an action against her, you will need to know if by doing so you are violating state or federal privacy laws. In the event that you are not violating any laws, you still should consider any potential for adverse issues to occur. Some concerns include: how others in the community would view you, would this negatively impact your practice, would doing this cause your patient to become angry and pursue a lawsuit or board of medicine complaint against you? Before taking any legal action against a patient, it is always advisable to obtain advice from an attorney to determine potential risks and benefits of doing so.


It can be challenging if a patient owes money for services. When handling, it is important to be aware of your state’s rules and regulations. It is also important to be aware of your professions’ ethical rules and regulations and any state board of medicine position on the issue. Should you have questions, consult your risk management professional or attorney.


About the Author

Kristen Lambert serves as the lead for risk management for professional liability policyholders and specialty programs. She specializes in risk management services for psychiatric providers and the behavioral health areas. Prior to joining Allied World, Kristen practiced as an attorney focusing on health law matters including medical malpractice defense. Kristen is admitted to the bars in Massachusetts and Connecticut and the U.S. District Court in Massachusetts. Kristen also has worked as a clinical social worker in community and tertiary hospitals as well as community mental health settings.

1 http://www.hhs.gov/hipaa/for-individuals/medical-records/index.html [last accessed 5/13/16].

2 45 CFR 164.524, http://www.hhs.gov/hipaa/for-professionals/faq/353/if-patients-request-copies-of-medical-records-are-they-required-to-pay-for-copies/index.html [last accessed 5/12/16].