Patient’s Bill of Rights

What is the Patient’s Bill of Rights?

There’s more than one Patient’s Bill of Rights

There’s no one single Patient’s Bill of Rights. What started in the early 1970’s has developed into several different kinds of declarations. An early bill of rights was drafted by the American Hospital Association to inform patients of what they could reasonably expect while in the hospital. It also offered a way for hospital staff to talk with patients about their care.

As health care has changed, other types of bills of rights have been written. The newer ones tend to discuss patients’ rights in dealing with insurance companies and other specific situations. For the most part, the older bills of rights still apply to the situations and settings for which they were written.

Patient’s rights and health insurance: the Affordable Care Act

In 2010, a new Patient’s Bill of Rights was created along with the Affordable Care Act. This bill of rights was designed to give new patient protections in dealing with insurance companies. Some of the protections started in 2010, but others will be phased in more slowly and take full effect in 2014. Here are some of the protections covered:

• Annual and lifetime limits to coverage are being phased out.
• In general, children will be able to get health insurance in spite of any medical conditions.
• Children are also now able to stay on a parent’s policy until age 26 if they meet other requirements.
• Health insurance companies will no longer be able to rescind (take back) your health coverage after you get sick because you made an honest mistake on your insurance application.

Still, there are exceptions even to these rights. As of late 2012, many existing health plans are “grandfathered”, meaning that they don’t have to follow the new rules as long as they keep an old plan in effect. The new rules only apply to plans issued or renewed on or after September 23, 2010. And, insurance plans may ask the US Department of Health and Human Services (DHHS) for waivers (exceptions) to some of the new requirements. The DHHS has already granted a number of these exceptions, so you will still have to check with each plan to find out exactly what they do and don’t do. These new rights may not apply to all patients for some time.

If you would like to read more about these rights and how they are being phased in, you can visit www.healthcare.gov/law/features/rights/bill-of-rights/index.html.

The Patient’s Bill of Rights

While these new rights from 2010 are taking effect, older bills of rights still apply. Here is a summary of the Consumer Bill of Rights and Responsibilities that was adopted by the US Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998.

This bill of rights also applies to the insurance plans offered to federal employees. Many other health insurance plans and facilities have also adopted these values. Even Medicare and Medicaid stand by many of them. This bill of rights addresses 8 key areas:

Information for patients

You have the right to accurate and easily-understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, help should be given so you can make informed health care decisions.

Choice of providers and plans

You have the right to choose health care providers who can give you high-quality health care when you need it.

Access to emergency services

If you have severe pain, an injury, or sudden illness that makes you believe your health is in danger, you have the right to be screened and stabilized using emergency services. You should be able to use these services whenever and wherever you need them, even if they’re out of your network, without needing to wait for authorization and without any financial penalty.

Taking part in treatment decisions

You have the right to know your treatment options and take part in decisions about your care. You have the right to ask about the pros and cons of any treatment, including no treatment at all. As long as you are able to make sound decisions, you have the right to refuse any test or treatment, even if it means you might have a bad health outcome as a result. You can also legally choose who can speak for you if you cannot make your own decisions.

Respect and non-discrimination

You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers that does not discriminate against you based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

Confidentiality (privacy) of health information

You have the right to talk privately with health care providers and have your health care information protected. You also have the right to read and copy your own medical record. You have the right to ask that your doctor change your record if it’s not correct, relevant, or complete.

Complaints and appeals

You have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals, or other health care personnel. This includes complaints about waiting times, operating hours, the actions of health care personnel, and the adequacy of health care facilities.

Consumer responsibilities

In a health care system that protects consumer or patients’ rights, patients should expect to take on some responsibilities. For instance, patients must tell their health care providers about any medicines they are taking, and about health conditions and medical or surgical problems in the past or present. Patients must ask questions or request further information from health care providers if they do not completely understand health information and instructions.

Patients must also take responsibility for their lifestyles to help improve their own health (for instance, following a treatment plan, exercising, and not using tobacco). Patients are expected to do things like treat health care workers and other patients with respect, try to pay their medical bills, and follow the rules and benefits of their health plan coverage. Having patients involved in their care increases the chance of the best possible outcomes and helps support a high quality, cost-conscious health care system.

Other bills of rights

The above bill of rights focuses on health insurance plans, but there are many others with different focuses. There are special kinds, like

• Mental health bill of rights
• Hospice patient’s bill of rights
• Rights of people in hospitals

Certain states in the US have their own bills of rights for patients. Insurance plans sometimes have lists of rights for subscribers. Many of these lists of rights tell you where to go or whom to talk with if you have a problem with your care. The American Hospital Association has a list of rights along with patient responsibilities that can help a person be a more active partner in his or her health care when in the hospital. (See the “To learn more” section below.)

Health insurance problems

If you have concerns about your insurance, it’s sometimes helpful to start with customer service or a case manager at your health insurance company. For information on dealing with insurance claims, see our document called Health Insurance and Financial Assistance for the Cancer Patient.

To learn more

More information from your American Cancer Society

Here is more information you might find helpful. You also can order free copies of our documents from our toll-free number, 1-800-227-2345, or read them on our Web site, www.cancer.org.

More about rights and responsibilities in health care

Informed Consent (also in Spanish)

Choosing a Doctor and a Hospital (also in Spanish)

Talking With Your Doctor (also in Spanish)

Health insurance and financial issues

Health Insurance and Financial Assistance for the Cancer Patient (also in Spanish)

Children Diagnosed With Cancer: Financial and Insurance Issues

National organizations and Web sites*

Along with the American Cancer Society, other sources of information and support include:

US Department of Health and Human Services
Web site: www.healthcare.gov/law/features/rights/bill-of-rights/index.html

This site explains new patient rights with regard to health insurance under the 2010 Affordable Care Act

American Hospital Association
Toll-free number: 1-800-242-2626 (this is the customer service/publication order line)
Web site: www.aha.org

AHA’s Patient Care Partnership brochure teaches patients about rights and responsibilities in regard to their hospital stay. (It comes in English, Arabic, Chinese, Russian, Spanish, Tagalog, and Vietnamese.) The brochure is sold in bulk orders only and there is a fee for non-members. But you can read it online for free, in any of the languages, at www.aha.org/aha/issues/Communicating-With-Patients/pt-care-partnership.html

National Library of Medicine
Web site: www.nlm.nih.gov/medlineplus/patientrights.html

This site has information on patient rights along with many links to other sources of related information

Medicare Rights Center (for those with Medicare)
Toll-free number: 1-800-333-4114
Web site: www.medicarerights.org

This service can help you understand your rights and benefits, work through the Medicare system, and get quality care. They can also help you find programs that help reduce your costs for prescription drugs and medical care, and guide you through the appeals process if Medicare denies coverage for drugs or care you need

No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call us at 1-800-227-2345 or visit www.cancer.org.

References

American Hospital Association. Management Advisory: A Patient’s Bill of Rights. Approved by the AHA Board of Trustees October 21, 1992. Accessed at www.patienttalk.info/AHA-Patient_Bill_of_Rights.htm on November 29, 2012.

Families USA. The Affordable Care Act: Patients’ Bill of Rights and Other Protections. April 2011. Accessed at http://familiesusa2.org/assets/pdfs/health-reform/Patients-Bill-of-Rights.pdf on November 29, 2012.

President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Consumer Bill of Rights and Responsibilities. Accessed at http://archive.ahrq.gov/hcqual/cborr/ on November 29, 2012.

US Department of Health and Human Services. Patient’s Bill of Rights. Accessed at www.healthcare.gov/law/features/rights/bill-of-rights/index.html on November 29, 2012.

US Office of Personnel Management. Patients’ Bill of Rights. Accessed at www.opm.gov/insure/health/reference/billrights.asp on November 29, 2012.