In 2010, the Affordable Care Act was signed into law. The act covers your relationship with insurers, health plans, and everyone else in the healthcare system. It contains health insurance reforms that began in early 2014, and will be modified as time goes on.. The goal of the act is to put American consumers back in charge of their health coverage and care.
A new Patient's Bill of Rights was created alongside the Affordable Care Act. Like most rights, it comes with certain obligations to take an active role in making the system run smoothly.
Some of the key features of the new Patient's Bill of Rights include:
- Coverage to Americans with pre-existing conditions under the Pre-Existing Condition Insurance Plan
- The ability to choose a primary care doctor from your plan's network
- Coverage for young adults under their parent's health plan until age 26
- A ban on lifetime limits on coverage for all new health insurance plans
- Benefits to children under 19 who may have previously been denied due to a pre-existing condition
- Insurance companies that must publicly justify rate hikes
- Premium dollars that must be spent primarily on healthcare and not on administrative costs
- Restricting annual dollar limits on coverage
- Preventing health care plans from requiring patients to pay higher copayments when seeking emergency care outside of their plan network
Originally passed in 1997, the Patients' Bill of Rights was designed to strengthen consumer confidence in the healthcare system, to provide a sound foundation on which to build quality doctor-patient relationships, and to spell out patients' rights to receive good care. It also obligates patients to take an active part in the management of their own health. While new features set out in the Affordable Care Act take affect, older rules in the Patient's Bill of Rights still apply.
The Bill set standards based on the ideal that no patient—like no citizen—should have more rights than any other. Whether you are enrolled in Medicare or Medicaid or are a veteran or government employee, whether you are covered by an employer or buy your own health insurance, and even if you have no healthcare coverage at all, this bill applies to you.
Beyond the basic belief in equality among patients, the Bill incorporates some other commonly accepted American attitudes. These are:
- Healthcare should be available to everyone
- Healthcare coverage must be affordable
- People who are particularly vulnerable deserve extra help
- Health insurers should use their premiums to pay a reasonable portion of the cost of care
- People should be encouraged to participate in the clinical trials that result in new medications and better approaches to illnesses
You must be able to receive accurate, easy-to-understand information about health plans, healthcare professionals, and hospitals and clinics so that you can choose your care wisely.
That means that you should:
- Have the details of your health plan spelled out clearly and precisely
- Be able to quickly learn about the education, licensure, experience, and any bad marks on the professional records of doctors and others healthcare providers
- Be able to quickly acquire a variety of statistics on hospitals and clinics, including how often certain procedures have been performed there, comparisons between them and other institutions, and how to lodge complaints against them
All health plans must offer you a wide enough range of coverage options so that you don't have to wait for any services you need. Women must have a choice of gynecological and obstetrical professionals, and anyone who needs the services of a specialist must be able to get them. If plans do not fulfill these basic provisions, you have the right to seek care outside of the plan at no additional cost.
Furthermore, if you have a chronic or disabling condition and your health plan terminates your provider's contract, you may be able to continuing seeing your provider for up to 90 days, unless the termination is for a cause. If you are in the second or third trimester of pregnancy, you may continue seeing your OB/GYN until the end of your postpartum care.
You should not need permission ahead of time to use emergency services if you have symptoms that a "prudent layperson"—meaning a reasonable person—would consider an emergency. While this stipulation may seem somewhat unclear, it is meant to prevent people from using the convenience of emergency rooms rather than scheduling appointments in a doctor’s office. This right also protects patients by ensuring they aren't held back from using emergency services by health plans attempting to save money.
Health plans should tell you where emergency services near you are located, and what you will be expected to pay when you use them. Keep in mind that health plans may have higher copays using the emergency room regardless of the reason. You should not be penalized if the nearest facilities available to you during an emergency are not in your network. And people who work in emergency departments should get in touch with your health plan as soon as possible.
One of the best ways to avoid having to use the emergency room is to make regular appointments when advised by your doctor. This may mean follow-up care, or lab or screening tests. The more control you take over your healthcare, the more it frees up emergency rooms for actual emergencies. If you have trouble taking time off from work, look for a provider with extended or weekend hours.
However, if you have good reason to think you are in trouble and shouldn't wait to see a doctor, you must be permitted to use emergency services.
You must be given all the information you need to make decisions about your healthcare. No one else can make those decisions for you—except under the following conditions:
- If you are unable to make decisions (due to physical or mental health reasons) and you have legally handed over that right to a designated family member or friend (health care proxy)
- If you are the responsibility of a person assigned to you by a court
Doctors and other healthcare professionals may recommend a particular course of action, but you must be informed of all other options and be given the opportunity to carefully consider those options before proceeding.
You have the right to refuse treatment. To make sure you can exercise that right, it is best to spell out ahead of time what kinds of treatments you want or don't want in case you become extremely ill and are unable to speak for yourself. A "living will" is one way to do that. For more information on living wills and related topics, see the article in this series entitled
End of Life Care.
You must be treated with respect and good manners, and may not be discriminated against for any reason, including sex, age, race, national origin, religion, sexual orientation, or disability.
Doctors should see you as soon as possible, and not keep you waiting any longer than is necessary. Once they see you, they should attempt to give you all the time you need to understand your diagnoses and explain your treatment options.
You must, in turn, treat healthcare professionals appropriately, and do what you can to promote mutual respect.
Healthcare professionals, insurers, and suppliers may not discuss your health history with employers or anyone else unless you give them permission to, except if the exchange of information is necessary for your care, and in some cases where the law or public health are concerned. For more information on your rights to privacy, see the article in this series entitled
HIPAA: Your Right to Health Care and Privacy.
You have the right to access any and all of your healthcare records. This gives you the responsibility to know what is in those records, and to find out if anyone has had unauthorized access to them.
You have the right to report and seek quick resolutions to any problems you have with your healthcare. Matters that might be of concern to you include billing, denied treatment, waiting times, how you have been treated, and lack of services.
All health plans, providers, and related institutions should have internal systems in place to handle both complaints and appeals. The process for these should be easy to understand and participate in, and all rules should be made known to you.
If you need external help, you can turn to state licensing agents and other protective agencies set up by each state.
Besides protecting your rights, the Patients' Bill of Rights also lists specific things you should do to help improve the quality of your care and the relationships you establish with healthcare professionals.
These include eating healthfully, making an effort to quit bad habits such as
smoking, taking an active interest in your doctors’ opinions and advise, carrying out treatments on which you and your doctors have agreed (including taking medications responsibly), and telling your doctors what they need to know.
Other responsibilities include taking care not to spread disease, showing respect for health workers, taking time to understand your health plans, doing the best you can to pay your bills, reporting fraud if you witness it, and following the rules and regulations governing your health plan.
Consumer Bill of Rights and Responsibilities: Report to the President of the United States prepared by Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Advisory Commission on Consumer Protection and Quality in the Health Care Industry website. Available at:
http://archive.ahrq.gov/hcqual/cborr. Updated July 17, 1998. Accessed August 8, 2014.
Key features of the Affordable Care Act. Health Insurance Marketplace website. Available at: http://www.hhs.gov/healthcare/facts/timeline/index.html. Accessed August 8, 2014.
Patient's bill of rights. American Cancer Society website. Available at:
http://www.cancer.org/Treatment/FindingandPayingforTreatment/UnderstandingFinancialandLegalMatters/patients-bill-of-rights. Updated January 6, 2014. Accessed August 8, 2014.
Patients' bill of rights. US Office of Personnel Management website. Available at: http://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=Bill-of-Rights. Accessed August 8, 2014.
Rights and protections. Health Insurance Marketplace website. Available at:
https://www.healthcare.gov/how-does-the-health-care-law-protect-me. Updated February 6, 2012. Accessed August 8, 2014.
Last reviewed August 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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