What is a Patient Bill of Rights?

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Did you know that the first Patient Bill of Rights was drafted by the American Hospital Association in the early 1970s? The goal was to empower patients in their medical care. Since then, several similar measures have been adopted at both the federal and state levels. The most recent federal version passed in 2010 as part of the Affordable Care Act (ACA). 

The Patient Bill of Rights in the Affordable Care Act has three major goals:

1. To help patients feel more confident in the US healthcare system, the Bill of Rights helps assure that the health care system is fair and it works to meet patients’ needs, gives patients a way to address any problems they may have, and encourages patients to take an active role in getting or staying healthy;

2. To stress the importance of a strong relationship between patients and their health care providers; and

3. To stress the key role patients play in staying healthy by laying out the rights and responsibilities for all patients and health care providers. The Bill of Rights also applies to insurance plans. 

Some of the specific protections that apply to health plans under the ACA law include:

  • Removal of annual and lifetime dollar limits on essential benefits, which include doctor and specialist visits, home and hospice services, emergency services, hospitalization, preventative and wellness services, chronic disease management, laboratory services, prescription drugs, maternity and newborn care, pediatric services, mental health care, substance use disorder services, and rehabilitative services and devices;
  • Eligibility for health insurance in spite of pre-existing medical conditions; 
  • The right to have 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 criteria; 
  • Entitlement to certain preventative screenings without paying extra fees or copays;
  • When a plan denies payment for a medical treatment or service, you must be told why it was refused and how to appeal or fight that decision; and
  • You have the right to appeal the payment decision of private health plans (internal appeals) as well as the right to a review by an independent organization (outside review) if the insurance company still will not pay.

There are Bills of Rights for other settings as well. These include the Mental Health Bill of Rights, Hospice Bill of Rights, and the Rights of People in Hospitals. Some states have additional bills of rights that may apply. 

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