There have been several attempts by Congress over the years to pass a formal Patient’s Bill of Rights. The intention has generally been to protect many basic rights of Americans when it comes to personal health care and dealing with insurance companies. The Affordable Care Act (ACA) cements many existing laws and rights to this end through an explicit new Patient’s Bill of Rights. The U.S. Departments of Health and Human Services, Labor and Treasury all collaborated on the new Patient’s Bill of Rights.
Many of the provisions of the new Patient’s Bill of Rights were enacted in 2010 when the ACA was signed into law. The rest will be phased in over time through 2014.
For detailed technical and regulatory information on the new Patient’s Bill of Rights as legislated through the ACA, visit the U.S. Centers for Medicare & Medicaid Services.
A simpler version, or outline of the new Patient’s Bill of Rights, has been created by HealthCare.gov. It breaks down the new Patient’s Bill of Rights into 11 distinct parts. Below is a summary of those 11 parts.
Part 1: Rights & Protections
The new Patient’s Bill of Rights was written so that potential patients and insurers are aware of the rules and regulations of the ACA. The most basic ways a patient is protected includes:
- Health plans cannot turn people down or charge them more because they are sick.
- Health plans cannot charge woman more.
- Insurance companies cannot charge more for mistakes on applications.
- People have a right to choose their own doctor from within their plan’s provisions.
- Many people under 26 years of age may join a parent’s plan.
- Many plans provide preventative health care services.
- The new law prevents health insurance providers from imposing life-limiting financial caps on coverage.
- The new law ensures that health insurance providers cannot raise rates beyond reasonable and necessary limits as regulated.
Part 2: The Health Insurance Marketplace
The marketplace serves as a new way to obtain quality health insurance. This marketplace allows buyers to compare plans which are generally priced more reasonably due to competition. The marketplace also houses Medicaid and the Children’s Health Insurance Program (CHIP).
Part 3: Coverage for Pre-Existing Conditions
In 2014, a patient cannot be refused coverage or charged more for having a pre-existing condition or for being ill.
Part 4: Summary of Benefits and Coverage
Each patient has the right to a plain language summary of their coverage and benefits, which also includes a summary of terms. This summary must be available in different languages upon request.
Part 5: Cracking Down on Frivolous Cancellations
Part 6: Doctor Choice & Emergency Room Access
Patients have the right to choose their own doctors and primary care physicians as well as have the option to use out-of-network emergency rooms without penalty. This also carries over to not requiring a referral for some specialists.
Part 7: Young Adult Coverage
Young adults under 26 now have several options for health care coverage. This includes being covered on their parent’s plan, even if they don’t live with them.
Part 8: Free Preventive Care
Most health insurances are required to cover the cost of certain preventive care services including preventive screenings.
Part 9: Ending Lifetime & Yearly Limits
There are two ways for patients to hold insurance companies accountable and keep costs down. First, the company must publicly explain and justify any rate increase over 10 percent. Second, they must adhere to the 80/20 rule. This means they must spend 80 percent of premiums on health care or improvement activities.
Part 11: Your Right to Appeal Coverage Decisions
Under the ACA, patients are now allowed to dispute and appeal any decisions made by a private insurance company.
For more information, read the full 11-part outline of the new Patient’s Bill of Rights from HealthCare.gov.
The information above was supplied and edited by James George via Examiner.com. James George began his career as an instructional media consultant and managed a broadcast quality tv studio for AT&T. He later became VP and Publisher for Hitchock Publishing Division of The American Broadcasting Companies. He was PR Director for Ensslin & Hall Advertising and managed the Media General Broadcast and Eden’s Broadcasting accounts as well as GTE. He founded Talon Publishing Inc which he sold to Daniel S. Appleton. Now, he writes thousands of articles on art, film, and politics.