When you receive healthcare services, you have certain rights and protections under U.S. law.  A number of regulations work together to guarantee these rights and protections.

Your rights include the following: 

• Information Disclosure. You have the right to receive accurate and easily understood information about your health plan, healthcare professionals and healthcare facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, assistance will be provided so you can make informed healthcare decisions. 
• Choice of Providers and Plans. You have the right to a choice of healthcare providers that is sufficient to provide you with access to appropriate high-quality healthcare.
• Access to Emergency Services. If you have severe pain, an injury, or sudden illness that convinces you that your health is in serious jeopardy, you have the right to receive screening and stabilization emergency services whenever and wherever needed, without prior authorization or financial penalty. 
• Participation in Treatment Decisions. You have the right to know all your treatment options and to participate in decisions about your care. Parents, guardians, family members, or other individuals that you designate can represent you if you cannot make your own decisions.
• Respect and Nondiscrimination . You have the right to considerate, respectful and nondiscriminatory care from your doctors, health plan representatives, and other healthcare providers.
• Confidentiality of Health Information. You have the right to talk in confidence with healthcare providers and to have your healthcare information protected. You also have the right to review and copy your own medical record and request that your physician amend your record if it is not accurate, 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 healthcare personnel. This includes complaints about waiting times, operating hours, the conduct of healthcare personnel, and the adequacy of facilities. Click here for information on the complaints and appeals process.

Patients’ rights were further expanded in 2010 through the adoption of the the Affordable Care Act. Under the new law:

You can:

• Receive cost-free preventive services. If your plan is subject to these new requirements, you would not have to pay a copay or any deductible to receive preventive health services, such as recommended screenings, vaccinations or counseling.
• Keep your dependent children on your health insurance plan until age 26. Previously, health plans could remove enrolled children, usually at age 19, and sometimes older for full-time students.
• Choose a primary doctor, ob/gyn and pediatrician. You can choose your physician from your health plan’s provider network without needing approval from another doctor.
• Seek emergency care outside your plan’s network without prior approval from your health plan.

Insurer’s can’t:

• Limit or deny benefits or deny coverage for a child younger than age 19 simply because the child has a “pre-existing condition”, a health problem that was developed before the child applied to join the plan.
• Put a “lifetime” dollar limit on most benefits you receive. The law also restricts and phases out the “annual” dollar limits a health plan can place on most of your benefits–and does away with these limits entirely in 2014.
• Retroactively cancel your insurance coverage solely because you or your employer made an honest mistake on your insurance application or left out information that has little bearing on your health.
• Deny you your right to appeal if the insurer will not pay for a service or treatment. When an insurance plan denies payment for a treatment or service, you can appeal to the plan to review its decision. Your plan must explain how to appeal when it informs you of the denial.

Background

The adoption of the Affordable Care Act marked a major milestone for our healthcare system. The Patient’s Bill of Rights took effect on September 23, 2010, putting an end to some of the worst insurance industry abuses. For more information, visit: Patient’s Bill of Rights.

In March 1998, the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry issued its final report, which included the Consumer Bill of Rights and Responsibilities. The Commission was appointed by President Bill Clinton, and co-chaired by Donna Shalala, Secretary of the Department of Health and Human Services. To view the Advisory Commission’s Final Report, visit: Consumer Bill of Rights and Responsibilities.

Federal civil rights laws and the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, together, protect your fundamental rights of nondiscrimination and health information privacy. Civil Rights help to protect you from unfair treatment or discrimination because of your race, color, national origin, disability, age, sex (gender), or religion. The Privacy Rule protects the privacy of your health information; it says who can look at and receive your health information, and also gives you specific rights over that information. In addition, the Patient Safety Act and Rule establish a voluntary reporting system to enhance the data available to assess and resolve patient safety and healthcare quality issues and provides confidentiality protections for patient safety concerns. To learn more, click here.