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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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.
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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).
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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
Tom V
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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)
Dr Deo
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