Patients Bill of Rights

What is the Patients Bill of Rights?

Theres more than one Patients Bill of Rights
In the early 1970s the American Hospital Association drafted a 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 different declarations, so that theres more than one version of the Patients Bill of Rights.
As health care has changed, newer bills of rights tend to discuss patients rights in dealing with insurance
companies and other specific situations. For the most part, the older bills of rights still apply to the
situations and settings for which they were written.

Patients rights and health insurance: the Affordable Care Act

In 2010, a new Patients 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 insurance companies. Some of the
protections started in 2010, but others were phased in more slowly and take full effect in 2014.
Here are some of the protections that apply to health plans under the new laws:

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 parents policy until age 26 if they meet certain requirements.

Youre 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 doesnt 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 dont 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 new rules apply to plans issued or renewed on or
after September 23, 2010. Going into 2014, some existing health plans are still grandfathered, meaning
they dont have to follow all of the new rules as long as they keep an old plan in effect. Youll need to
check your plans 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 youll still have to check with each plan to find out exactly what they do and dont do.
If you would like to read more about these rights, you can visit www.healthcare.gov/how-does-the-healthcare-law-protect-me.

The Consumer Bill of Rights and Responsibilities

While these new rights from 2010 are taking effect, older bills of rights still apply. Here is a summary of
the Consumer Bill of Rights and Responsibilities that was adopted by the US Advisory Commission on
Consumer Protection and Quality in the Health Care Industry in 1998.
This bill of rights applies to the insurance plans offered to federal employees. Many other health
insurance plans and facilities have also adopted these values. Even Medicare and Medicaid stand by
many of them. This bill of rights addresses 8 key areas:

Information for patients

You have the right to accurate and easy-to-understand information about your health plan, health care
professionals, and health care facilities. If you speak another language, have a physical or mental
disability, or just dont understand something, help should be given so you can make informed health care
decisions. See our document called Informed Consent for more information on getting information to
make health decisions.

Choice of providers and plans

You have the right to choose health care providers who can give you high-quality health care when you
need it.

Access to emergency services

If you have severe pain, an injury, or sudden illness that makes you believe your health is in danger, you
have the right to be screened and stabilized using emergency services. You should be able to use these
services whenever and wherever you need them, even if theyre out of your network, without needing to
wait for authorization and without any financial penalty.

Taking part in treatment decisions

You have the right to be informed about your treatment options and take part in decisions about your
care. You have the right to ask about the pros and cons of any treatment, including no treatment at all. As
long as you are able to make sound decisions, you have the right to refuse any test or treatment, even if it
means you might have a bad health outcome as a result. You can also legally choose someone who can
speak for you if you cannot make your own decisions. See our document called Advance Directives for
more information on appointing someone to do this.

Respect and non-discrimination

You have a right to considerate, respectful care from your doctors, health plan representatives, and other
health care providers that does not discriminate against you based on race, ethnicity, national origin,
religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of
payment.

Confidentiality (privacy) of health information

You have the right to talk privately with health care providers and have your health care information
protected. You also have the right to read and copy your own medical record. You have the right to ask
that your doctor change your record if its not correct, 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 health care personnel. This includes complaints about waiting times, operating
hours, the actions of health care personnel, and the adequacy of health care facilities.

Consumer responsibilities
In a health care system that protects consumer or patients rights, patients have certain responsibilities.
For instance, patients must tell their health care providers about any drugs or supplements they are
taking, and about health conditions and medical or surgical problems in the past or present. Patients must
ask questions or request further information from health care providers if they do not completely
understand health information and/or instructions theyve been given.

Patients must also take responsibility for their lifestyles to help improve their own health. (For instance,
following a treatment plan, exercising, and not using tobacco.) Having patients involved in their care
increases the chance of the best possible outcomes and helps support a high quality, cost-conscious
health care system.
Patients are also expected to do things like treat health care workers and other patients with respect, try
to pay their medical bills, and follow the rules and benefits of their health plan coverage.

Other bills of rights

The 2 bills of rights discussed so far focus on health insurance plans, but there are others for different
settings, like these:

Mental health bill of rights

Hospice patients bill of rights

Rights of people in hospitals

Certain US states have their own bills of rights for patients. Insurance plans sometimes have lists of rights
for subscribers. Many of these lists of rights tell you where to go or whom to talk with if you have a
problem with your care.
The American Hospital Association (AHA) has a list of patient rights and responsibilities that can help a
person be a more active partner in his or her health care when in the hospital. Its an updated version of
the first bill of rights from the AHA. (See the To learn more section below.)

Health insurance problems

If you have concerns about your insurance, its sometimes helpful to start with customer service or a case
manager at your health insurance company. For information on dealing with insurance claims, see our
document called Health Insurance and Financial Assistance for the Cancer Patient.

To learn more
More information from your American Cancer Society
Here is more information you might find helpful. You also can order free copies of our documents from our
toll-free number, 1-800-227-2345, or read them on our website, www.cancer.org.

More about rights and responsibilities in health care

Informed Consent (also in Spanish)
Choosing a Doctor and a Hospital (also in Spanish)
Talking With Your Doctor (also in Spanish)

Health insurance and financial issues

Health Insurance and Financial Assistance for the Cancer Patient (also in Spanish)
Children Diagnosed With Cancer: Financial and Insurance Issues

National organizations and websites*

Along with the American Cancer Society, other sources of information and support include:
US Department of Health and Human Services
Website: www.healthcare.gov/how-does-the-health-care-law-protect-me
This site explains new patient rights with regard to health insurance under the 2010 Affordable Care
Act
American Hospital Association
Toll-free number: 1-800-242-2626 (this is the customer service/publication order line)
Website: www.aha.org
AHAs 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 theres 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-carepartnership.html.
National Library of Medicine
Website: www.nlm.nih.gov/medlineplus/patientrights.html
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
Website: www.medicarerights.org
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.
No matter who you are, we can help. Contact us anytime, day or night, for information and support. Call
us at 1-800-227-2345 or visit www.cancer.org.

References
American Hospital Association. Management Advisory: A Patients Bill of Rights. Approved by the AHA
Board of Trustees October 21, 1992. Accessed at www.patienttalk.info/AHA-Patient_Bill_of_Rights.htm on
January 3, 2014.
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.
Families USA. The Affordable Care Act: Patients Bill of Rights and Other Protections. April 2011.
Accessed at http://familiesusa2.org/assets/pdfs/health-reform/Patients-Bill-of-Rights.pdf on January 2,
2014.
Presidents 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 January 3, 2014.
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 January 3, 2014.

Patient's Bill of Rights and Responsibilities

Health care at McKinley Health Center is a cooperative effort between the patient
and the health care provider. The McKinley Health Center staff would like
patients to be aware of their rights as well as their responsibilities.

Rights as a health care consumer

The patient has the right to considerate and respectful care, regardless of
gender, race, sexual orientation, age, culture, disabilities, or religious beliefs.

The patient has the right to make informed choices about health products,
health services, and health care practitioners and has the right to change their
provider.

The patient has the right to receive complete and current information
concerning his/her diagnosis and treatment from McKinley Health Center. When
the patient is unable to comprehend medical information, the information will be
made available to a person designated or authorized by the patient, on the
patient's behalf.

The patient has the right to receive all of the necessary and pertinent
information to make informed decisions about health care treatment.

The patient has the right to an appropriate assessment and effective

management of pain.

The patient has the right to refuse treatment and to be informed of the
medical consequences of that action.

The patient has the right to every consideration of privacy regarding the
medical care provided and to a copy of our Notice of Privacy Practices.

The patient has the right to expect that all communications and records
pertaining to health care will be treated as confidential. Patients will be afforded
the opportunity to approve or refuse the release of records, except when
required by law.

The patient has the right to expect that, within its capacity and scope of
services, McKinley Health Center will make all reasonable efforts to provide
requested services.

The patient has the right to know what relationship McKinley Health Center
has with other health care providers and facilities in regard to his/her own health
care.

The patient has the right to know if McKinley Health Center is engaging in
research about health care and the right to refuse participation in such research.

The patient has the right to expect reasonable continuity of health care.

The patient has the right to examine and receive an explanation of costs for
treatment when applicable.

The patient has the right to register complaints regarding health care services
with the health care provider and/or administration.

Responsibilities as a health care consumer

The patient has the responsibility to ask questions if he/she does not
understand the explanation of the diagnosis, treatment, prognosis, or any
instructions.

The patient has the responsibility to follow instructions concerning

medications, follow-up visits, education and transportation recommendations,
other essential steps in the treatment plan and to notify the health care provider if
this plan cannot be followed or if problems develop.

The patient has the responsibility for treating Health Center personnel and
other patients in a respectful manner.

The patient has the responsibility to arrive as scheduled for appointments and
to notify the Health Center in advance in case of canceled appointments.

The patient has the responsibility to carry health insurance as required by the
University of Illinois, be familiar with policy coverage and accept personal
financial responsibilities not covered by insurance.

The patient has the responsibility to give his/her health care provider
complete and accurate information to assist in the assessment of medical needs,
including any advance directives.
http://www.mckinley.illinois.edu/handouts/bill_rights_responsibilities.html

Patient Bill of Rights

The American Hospital Association developed "A Patient's Bill of Rights" with the belief that it will add to more
effective patient care and be supported by the hospital on behalf of the organization, its medical staff, employees, and
patients.
Health care involves a partnership between patients and doctors and other health care professionals. Open
communication, respect for personal and professional standards, and understanding of differences are important for
the best possible patient care. Hospitals should:

Provide a base for understanding and respecting the rights and responsibilities of patients, their families,
doctors, and other caregivers;

respect the role of patients in decision making about treatment choices and other care; and

be aware of cultural, racial, language, religious, age, gender, and other differences as well as the needs of
persons with disabilities.

Hospitals have many functions to perform, including treating injury and disease, health promotion and prevention,
rehabilitation of patients, education of health professionals, patients, and the community, and research. All these
activities should be conducted with concern for the values and dignity of patients.
The following information was adapted from the American Hospital Association's "A Patient's Bill of Rights". It is not a
State law.
A Patient's Bill of Rights
Another person chosen by the patient can exercise these rights on the patient's behalf. A proxy decision maker can
exercise these rights if the patient lacks decision-making ability, is legally incompetent, or is a minor.

The patient has the right to considerate and respectful care.

The patient has the right to and is encouraged to obtain from doctors and other direct caregivers
appropriate, current, and understandable information about diagnosis, treatment, and prognosis. Except in
emergencies when the patient lacks decision-making ability and the need for treatment is urgent, the patient

is entitled to the chance to discuss and request information about the specific procedures and/or treatments,
the risks involved, the possible length of recuperation, and the medically reasonable alternatives and their
risks and benefits. Patients have the right to know the identity of doctors, nurses, and others involved in their
care, as well as when those involved are students, patients, or other trainees. The patient also has the right
to know the immediate and long-term financial implications of treatment choices, insofar as they are known.

The patient has the right to make decisions about the plan of care before and during treatment. The patient
has the right to refuse a recommended treatment or plan of care to the extent allowed by law and hospital
policy and to be informed of the medical consequences of this action. In case of refusal, the patient is
entitled to other appropriate care and services that the hospital provides or transfers to another hospital. The
hospital should notify patients of any policy that might affect patient choice within the institution.

The patient has the right to have an advance directive (such as a living will, health care proxy, or durable
power of attorney for health care) concerning treatment or designating a surrogate decision maker with the
expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital
policy. Health care institutions must tell patients of their rights under state law and hospital policy to make
informed medical choices, ask if the patient has an advance directive, and include that information in patient
records. The patient has the right to timely information about hospital policy that may limit its ability to
implement fully a legally valid advance directive.

The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and
treatment should be conducted so as to protect each patient's privacy.

The patient has the right to expect that all communications and records related to his/her care will be treated
as confidential by the hospital, except in cases such as suspected abuse and public health hazards when
reporting is permitted or required by law. The patient has the right to expect that the hospital will stress the
confidentiality of this information when it releases it to any other parties entitled to review information in
these records.

The patient has the right to review the records about his/her care and to have the information explained or
interpreted as necessary, except when restricted by law.

The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable
response to a patient's request for appropriate and medically indicated care and services. The hospital must
provide evaluation, service, and/or referral as indicated by the urgency of the case. When medically
appropriate and legally permitted, or when a patient has requested, a patient may be transferred to another
facility. The institution to which the patient is to be transferred must first have accepted the patient for
transfer. The patient must also have the benefit of complete information and explanation concerning the
need for, risks, benefits, and alternatives to such a transfer.

The patient has the right to ask and be informed of business relationships among the hospital, educational
institutions, other health care providers, or payers that may influence the patient's treatment and care.

The patient has the right to consent to or decline to take part in research studies or human experimentation
affecting care and treatment or requiring direct patient involvement, and to have those studies fully explained
prior to consent. A patient who declines to take part in research or experimentation is entitled to the most
effective care that the hospital can otherwise provide.

The patient has the right to expect reasonable continuity of care when appropriate and to be informed by
doctors and other caregivers of available and realistic patient care options when hospital care is no longer
appropriate.

The patient has the right to be informed of hospital policies and practices that relate to patient care
treatment, and responsibilities. The patient has the right to be informed of available resources for resolving
disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other
mechanisms available in the institution. The patient has the right to be informed of the hospital's charges for
services and available payment methods.

Patient Responsibilities
The partnership nature of health care requires that patients, or their families/surrogates, take part in their care. The
effectiveness of care and patient satisfaction with the treatment depends, in part, on the patient fulfilling certain
responsibilities. The following are patient responsibilities:

Patients are responsible for providing information about past illnesses, hospitalizations, medications, and
other matters related to health status. To participate effectively in decision making, patients are take
responsible for asking for additional information or explanation about their health status or treatment when
they do not fully understand information and instructions.

Patients are also responsible for ensuring that the health care institution has a copy of their written advance
directive if they have one.

Patients are responsible for telling their doctors and other caregivers if they expect problems in following
prescribed treatment.

Patients should be aware of the hospital's duty to be reasonably efficient and fair in providing care to other
patients and the community. The hospital's rules and regulations are intended to help the hospital meet this
responsibility. Patients and their families are responsible for making reasonable accommodations to the
needs of the hospital, other patients, medical staff, and hospital employees.

Patients are responsible for giving necessary information for insurance claims and for working with the
hospital to make payment arrangements, when necessary.

A person's health depends on much more than health care services. Patients are responsible for recognizing
the impact of their lifestyle on their personal health.

Reference: www.aha.org