Thanks to all who've replied so far. It's clear that there's a wide range of policies, and I've just been lucky in not having encountered the paywall before. (The radiology place gives me a disc for free when I leave; one regional health complex took forever but eventually sent me all my records electronically; Quest, our bloodlab chain, lets me designate up to three doctors to be sent the results, but they ALSO have a web site where I can eventually get them myself.)

Regarding Ginnie's point that the third-party records companies are trying to recover their costs, the cost seems awfully disproportionate--over a dollar per page. And surely all this information is in digital form, so it would be fairly inexpensive just to e-mail me a copy. In short, this IS clearly just another way for somebody to make money from our medical problems. But i wish we could resist somehow.