Patient’s Bill of Rights
There’s more than one Patient’s Bill of Rights
In the early 1970’s the American Hospital Association drafted a Patients’ Bill of Rights to inform patients of what they could reasonably expect while in the hospital. Since then, various groups have developed a number of similar measures:
- To empower people to take an active role in improving their health,
- To strengthen the relationships people have with their health care providers
- To establish patients’ rights in dealing with insurance companies and other specific situations related to health coverage.
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 health coverage by insurance companies.
Here are some of the protections that apply to health plans under the law:
- Annual and lifetime dollar limits to coverage of essential benefits have been removed. (Essential benefits include doctor and specialist visits, home and hospice services, emergency services, hospitalization, preventive and wellness services, chronic disease management, laboratory services, prescription drugs, maternity and newborn care, pediatric services, mental health and substance use disorder services, and rehabilitative services and devices. Non-essential benefits include things like adult dental care.)
- People will be able to get health insurance in spite of pre-existing medical conditions (medical problems they have before getting insurance).
- You have the right to an easy-to-understand summary of benefits and coverage.
- Young adults are able to stay on a parent’s policy until age 26 if they meet certain requirements.
- You’re entitled to certain preventive screening without paying extra fees or co-pays.
- If your plan denies payment for a medical treatment or service, you must be told why it was refused, and how to appeal (fight) that decision.
- You have the right to appeal the payment decisions of private health plans (called an “internal appeal”). You also have the right to a review by an independent organization (called an “outside review”) if the company still doesn’t want to pay.
- Larger insurance companies must spend 80% to 85% of their premiums on health care and improvement of care rather than on salaries, overhead, and marketing.
- If you made an honest mistake on your insurance application, health insurance companies will no longer be able to rescind (take back) your health coverage after you get sick. (They can still cancel coverage if you don’t pay premiums on time, if you lied on your application form, or if they no longer offer plans in your region.)
- If a company does cancel your coverage, they must give you at least 30 days’ notice.
- Premium increases of more than 10% must be explained and clearly justified.
Still, there are exceptions to some of these rights. The rules apply to plans issued or renewed on or after September 23, 2010. You’ll need to check your plan’s materials or ask your employer or benefits person to find out if your health plan is grandfathered.
Besides the grandfathered plans, there are other ways insurance companies can bypass some of the rules. 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’ll still have to check with each plan to find out exactly what they do and don’t do.
If you would like to read more about these rights, you can visit www.healthcare.gov/how-does-the-health-care-law-protect-me.
Other bills of rights
The Bill of Rights discussed so far focuses on health insurance coverage, but there are others for different settings, like these:
- Mental health bill of rights
- Hospice patient’s bill of rights
- Rights of people in hospitals
Certain US states have their own versions of a bill of rights for patients. Insurance plans sometimes have lists of rights for subscribers.
The American Hospital Association (AHA) has a document called The Patient Care Partnership that replaced the AHA’s Patients’ Bill of Rights. This brochure can help a person be a more active partner in his or her health care when in the hospital. (See the “Additional resources” section below.)
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 Managing Your Health Insurance.
The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Along with the American Cancer Society, other sources of information and support include:
US Department of Health and Human Services
This site explains patient rights with regard to health insurance under the Affordable Care Act
American Hospital Association
Toll-free number: 1-800-242-2626 (this is the customer service/publication order line)
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’s a fee for non-members. 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
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
This service can help you understand your rights and benefits, work through the Medicare system, and get quality care. They have newsletters, fact sheets, and a place to submit questions. 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
*Inclusion on this list does not imply endorsement by the American Cancer Society.
American Hospital Association. Management Advisory: A Patient’s Bill of Rights. Approved by the AHA Board of Trustees October 21, 1992.
Centers for Medicare & Medicaid Services, the Center for Consumer Information and Insurance Oversight, Fact Sheets and Frequently Asked Questions. Accessed at www.cms.gov/cciio/Resources/Fact-Sheets-and-FAQs/index.html#Review of Insurance Rates on January 2, 2014.
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 January 3, 2014.
US Department of Health and Human Services. How does the health care law protect me? Accessed at www.healthcare.gov/how-does-the-health-care-law-protect-me/ on May 18, 2016.
US Department of Health and Human Services. What if I have a grandfathered health insurance plan? Accessed at: www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/ on January 3, 2014.
US Office of Personnel Management. Patients’ Bill of Rights. Accessed at www.opm.gov/insure/health/reference/billrights.asp on May 18, 2016.
Last Medical Review: January 6, 2014 Last Revised: May 24, 2016