In New York, USA, If I go to my doctor's office and request that they order a specific blood test for me, can they refuse? Is there anything in HIPAA (or other laws) that compels a medical professional to order a test that has been requested by their patient?
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10I didn't DV, but at least HIPAA is a medical record security/privacy act, not much else.– Ron BeyerMar 16, 2021 at 19:07
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42I know that HIPAA is a federal act and violation is punishable, but HIPAA doesn't cover what a medical professional is compelled to do, it is simply an act outlining the rights of patient data and its security. It would be no different than citing the "Copyright Act", sure, violating it is a federal crime, but it doesn't apply here.– Ron BeyerMar 16, 2021 at 19:13
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3HIPAA violations are often federally punishable, but are often not crimes.– ohwillekeMar 16, 2021 at 19:49
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1Maybe it would help if you knew what the abbreviation HIPAA stands for: Health Insurance Portability and Accountability Act. Nothing about standards of medical care.– BarmarMar 17, 2021 at 15:45
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2Doctors have fairly large leeway available to them to deny a specific request, the ethics of a medical professional demands it. Do no harm. If any medical professional is of the opinion that a treatment would cause harm, they are obliged to put the syringes down, so to say.– StianMar 18, 2021 at 11:14
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4 Answers
There is no such legal requirement coming from federal or NY state law. Doctors can refuse treatment when the patient is abusive or the matter is outside the scope of their practice, and that can include a test which requires skills, equipment or a contractual relationship that they don't have. Also if a procedure conflicts with their professional duties (that is a large loophole), they do not have to perform a requested service: an example is prescribing antibiotics for a viral infection. There is also a federal regulation known as the conscience rule which is conceivably applicable. If the test is medically unnecessary (e.g. a covid antibody test "just for the heck of it") it would be illegal for the physician to perform the test and bill the insurance, though not illegal to do the test and have the patient pay, unless their agreement with the insurance company precludes any and all unnecessary treatments (regardless of whether the patient pays). That is, you cannot compel the doctor to breach his contract with the insurance company. If they do perform the test, then according to HIPAA, they have to tell you the results.
answered Mar 16, 2021 at 19:11
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10Doctors have no duty to perform under most laws of the country, especially if it violates religious or personal beliefs (for example performing sex-change operations). Religious and moral objections for medical service are federally protected. Mar 16, 2021 at 19:16
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4@RonBeyer They do have an ethical duty to refer you to someone willing to treat you but I don't know if this is legal or only under professional ethics codes (partner is a provider). Mar 16, 2021 at 19:35
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2Could it be illegal to authorize an unnecessary test if it were dangerous, regardless of who pays for it? E.g. a patient demanding to have X-rays taken each day.– SJuan76Mar 17, 2021 at 8:54
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3If the test is medically unnecessary, it is probably unethical for the doctor to order it regardless of who pays, and surely the law protects the doctor in the exercise of professional judgment not to order a medically unnecessary test. In other words, I would add professional judgment of lack of necessity to the reasons given that can justify a doctor's refusal to treat a patient.– phoogMar 17, 2021 at 13:42
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@phoog sure they could but in reality the majority of doctors are just going to do the test if it's only a simple blood draw or something like that, even if they don't think it is necessary. Doctors are a business and most the time they just give in rather than risk losing a client. All one has to do is look at the professions cozy relationship with pharma reps to see that ethics is a rather flexible topic.– epsMar 17, 2021 at 17:43
If I go to my doctor's office and request that they order a specific blood test for me, can they refuse?
Yes.
Is there anything in HIPAA (or other laws) that compels a medical professional to order a test that has been requested by their patient?
Generally, no.
Unless the medical professional has entered into a contract to provide it with the patient directly already, which would be a breach of contract and also quite unusual, there is no legal obligation to do so. The remedy a patient has when a medical professional refuses to do it is to find another medical professional who will (if possible).
This said, ER departments have an obligation to evaluate and stabilize anyone who appears on their door subject to limited resources which ER departments are obligated to resolve through an approved triage procedure. And, declining to do a test that is necessary to meet the professional standard of care of a physician properly could constitute tortious professional malpractice by the doctor.
But, in that fact pattern, the wrong is not disobeying an order of a patient. Whether the patient asks for the test or not is irrelevant. The wrong is not ordering a test when a reasonable doctor would have done so under the circumstances, when that failure to meet the standard of care actually harms the patient.
Also, ordering a medically unnecessary or inappropriate test would violate the standard of care for a medical professional and could be actionable if harm resulted (although this is much less likely to happen and the harm is likely to be much smaller which is why usually medical professionals practice "defensive medicine" and order too many tests, rather than too few, in an uncertain situation).
answered Mar 16, 2021 at 19:43
To go beyond what the accepted answer says (that they can refuse) in many circumstances they in fact MUST refuse.
Every conceivable test incurs some element of risk. Inserting a needle to draw blood risks nerve damage and infection, for example. These risks may be very small, but if the value of the information gained from the test is even smaller, then the doctor has a duty of care to refuse your request.
For example, if a (biological) male asked for a pregnancy test, the doctor easily can answer their question without any invasive process.
For some good information why doctors don't do unnecessary tests, see https://www.youtube.com/watch?v=7kQk9-KLPfU
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Pregnancy test maybe isn't the greatest example as they're not invasive. There's no risk from peeing in a cup, and doctors do them all the time when there's no value in it.– KatMar 18, 2021 at 18:42
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What if there was an earthquake while you were peeing? The consequences could be disastrous.– Tom VMar 18, 2021 at 18:58
Insurance companies are usually under no obligation to pay for tests that make no medical sense.
You have 2 options
- Ask your doctor nicely and if it makes medical sense to perform the test basing on your symptoms, I don't see why not.
- Pay for the test directly out of pocket and still ask nicely :) The doctor can still refuse to perform the test if it will cause you harm. (Hippocratic oath binds us to first of all do no harm)
