The Patient Bill of Rights: Your Right to Respect and Good Care
The Affordable Care Act was signed into law in 2010. The act covers how Americans interact with insurers, health plans, and others in the healthcare system. It contains health plan reforms that began in early 2014. These will be changed as time goes on. The goal of the act is to put consumers back in charge of their health coverage and care.
A new Patient's Bill of Rights was created alongside the Affordable Care Act. Some of the key features are:
- Coverage to people with pre-existing health problems 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 plans
- Benefits to children under 19 who may have previously been denied due to a pre-existing health problems
- Insurance companies that must publicly justify rate hikes
- Premium dollars that must be spent healthcare and not on administrative costs
- Restricting annual dollar limits on coverage
- Preventing health 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 effect, 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.
The Bill includes other commonly accepted American attitudes, such as:
- Healthcare should be available to everyone
- Healthcare coverage must be affordable
- People who are in need deserve extra help
- Health insurers should use their premiums to pay a reasonable portion of the cost of care
- People should be encouraged to take part in clinical trials that may result in new medicines and treatments
The Right to Information About Quality
You must be able to receive accurate, easy-to-understand information about health plans, healthcare professionals, and hospitals and clinics. It can help you choose your care wisely.
That means that you should:
- Have all the details about your health plan
- Be able to quickly learn about the education, license, experience, and any concerns about the records of doctors and other care providers
- Be able to access statistics on hospitals and clinics, such as how often they do certain procedures, how they compare to other institutions, and how to file complaints against them
The Right to Choose a Healthcare Provider
All health plans must offer you a wide range of coverage options so you don't have to wait for needed services. 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 provide these, then you have the right to seek care outside of the plan at no additional cost.
If you have a chronic or disabling condition and your health plan terminates your provider's contract, you may be able to keep 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.
The Right to Emergency Services
You should not need permission to use emergency services if you have symptoms that a reasonable person would consider an emergency. This is meant to prevent people from using emergency rooms instead of scheduling appointments in a doctor’s office. This right also protects patients by making sure they aren't held back from using emergency services by health plans trying to save money.
Health plans should tell you where emergency services near you are located. You should also be told what you will be expected to pay when you use them. Keep in mind that health plans may have higher copays for using an emergency room. You should not be penalized if the nearest emergency facilities are not in your network. And people who work in emergency departments should get in touch with your health plan as soon as possible.
Making regular appointments with your doctor is one of the best ways to avoid having to use the emergency room. 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 think you are in trouble and shouldn't wait to see a doctor, you must be allowed to use emergency services.
The Right to Make Decisions
You must be given all the information you need to make decisions about your care. The only time someone can make those decisions for you is when you are:
- Unable to make decisions (due to physical or mental health reasons) and you have legally handed over that right to a health care proxy
- The responsibility of a person assigned to you by a court
Doctors and other healthcare providers may suggest a particular care plan. You must be told about all the options and be given a chance to consider them before moving forward.
You have the right to refuse treatment. Talk to your providers about which treatments you want or don't want. It will help your doctor if you become very sick and can't speak for yourself. A living will is one way to do that. For more information, see the article in this series entitled End of Life Care.
The Right to Respect
You must be treated with respect and good manners. You may not be discriminated against for any reason, such as sex, age, race, national origin, religion, sexual orientation, or disability.
Doctors should see you as soon as possible. You should not be kept waiting any longer than needed. After you are seen, you should be given time to understand your condition and treatment options.
You must also treat healthcare providers appropriately and do what you can to promote mutual respect.
The Right to Confidentiality
Healthcare professionals, insurers, and suppliers may not discuss your health history with employers or anyone else unless you give them permission. The only exception is when an exchange of information is needed for your care, or where the law or public health are concerned. For more information, 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 health records. You are responsible for knowing what is in those records. You can also find out if anyone has had unauthorized access to them.
The Right to Complain
You have the right to report and seek resolution 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 complaints and appeals. The process for these should be easy to understand and take part in. 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.
The Patients' Bill of Rights also lists things you should do to help improve the quality of your care and the relationships you have with healthcare providers. These include eating healthfully, trying to quit bad habits like smoking, taking an active interest in your care, having the treatments that you and your doctors have agreed on, 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 when you see it, and following the rules and regulations governing your health plan.
US Department of Health & Human Services
About the Affordable Care Act. Health Insurance Marketplace website. Available at: https://www.hhs.gov/healthcare/about-the-aca/index.html. Accessed October 19, 2021.
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. Accessed October 19, 2021.
The patient bill of rights. American Cancer Society website. Available at: https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-financial-and-legal-matters/patients-bill-of-rights.html. Accessed October 19, 2021.
Patients' bill of rights. US Office of Personnel Management website. Available at: https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/#url=Bill-of-Rights. Accessed October 19, 2021.
Rights and protections. HealthCare.gov website. Available at: https://www.healthcare.gov/health-care-law-protections. Accessed October 19, 2021.
Last reviewed October 2021 by EBSCO Medical Review Board Last Updated: 10/19/2021