Detailed Answer

Understanding the Importance of Medical Records and Bills

Medical records and bills form the backbone of any injury claim. They document your diagnosis, treatment and expenses. Insurers and courts rely on these records to assign value to your injury, calculate damages and verify the necessity of care.

Steps to Gather Medical Records in Texas

1. Identify all providers: List every doctor, hospital, imaging center and therapist who treated you. Don’t forget ambulance services.
2. Sign a HIPAA-compliant authorization: Use the U.S. Department of Health & Human Services form (45 CFR §164.508). This lets providers release your records.
3. Request records under Texas law: Ask in writing per Tex. Health & Safety Code §241.153. Providers must respond within 15 business days. Link: https://statutes.capitol.texas.gov/Docs/HS/htm/HS.241.htm
4. Pay reasonable fees: Under Texas law, providers may charge up to $25 for the first 20 pages, $0.50 per additional page, plus a $20 preparation fee.
5. Obtain itemized bills: Ask each provider for an itemized statement listing dates of service, CPT codes and charges. This clarifies what each treatment cost.
6. Collect Explanation of Benefits (EOBs): If your health insurer paid part of your bills, request EOBs showing amounts paid and patient responsibility.
7. Organize chronologically: Group records and bills by date of service to create a clear timeline.

Submitting Records to the Insurer or Attorney

Once you’ve gathered all documents, follow these best practices:

• Create a cover letter: Summarize key facts: date of accident, injuries, list of attached records.
• Use certified mail or secure portal: Send submissions with delivery confirmation. If you work with an attorney, use their secure client portal.
• Keep duplicates: Retain copies of everything you send. Label digital files clearly (e.g., “2023-05-10_XRay_ABCClinic.pdf”).
• Follow insurer guidelines: Many carriers have online claim portals. Check deadlines in your policy.
• Track responses: Note when the insurer or attorney acknowledges receipt. Follow up if you don’t hear back within 2 weeks.

What to Include in Your Submission

• Signed authorization for records release
• All medical records (ER notes, imaging, lab reports)
• Itemized medical bills with CPT codes
• Explanation of Benefits (EOB) statements
• Record of out-of-pocket expenses (receipts for prescriptions, travel)
• Cover letter summarizing your injuries and attachments

Relevant Texas Statutes

• Texas Health & Safety Code §241.153 (Patient access to records): https://statutes.capitol.texas.gov/Docs/HS/htm/HS.241.htm
• Texas Rules of Civil Procedure Rule 192.3 (Scope of discovery): https://www.txcourts.gov/media/1451/2020-texas-rules-civil-procedure.pdf
• 45 CFR §164.508 (HIPAA authorization requirements): https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164#p-164.508

Disclaimer

This article is for informational purposes only and does not constitute legal advice. Consult a qualified attorney for advice on your specific situation.

Helpful Hints

• Request records early to avoid delays.
• Check each provider’s record request form online.
• Keep a spreadsheet tracking requests, fees and delivery dates.
• Use clear labels for physical and digital folders.
• Consider scanning paper records to PDF for easy sharing.
• Review bills for errors or duplications before submitting.
• Follow up promptly if a provider misses the 15-day deadline.