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What Is the Patient’s Bill of Rights?

The American Hospital Association (AHA) published its initial Patient Bill of Rights in 1973 to establish fundamental rights, responsibilities, and expectations for hospitals, insurance companies, and medical patients alike. Several organizations have updated variations of this list, including measures set forth by the federal government in the Affordable Care Act. Regardless of their minute differences, the AHA and ACA versions of the Patient Bill of Rights both ultimately exist to protect all individuals needing fair, affordable, and transparent medical care.

The Importance of Understanding Your Protections 

The Patient Bill of Rights helps people in various medical situations take an active role in improving their health and make informed decisions when communicating with hospitals and insurance companies.

These and other protections set forth by the ACA, AHA, EMTALA, and HIPAA help patients build stronger relationships with their healthcare providers, understand their financial responsibilities, and advocate for quality care without discrimination or jeopardization of their private information. Likewise, the ability to complain, appeal, and take legal action over medical malpractice, financial exploitation, and general neglect empowers patients in otherwise vulnerable positions.

What The Patient Bill of Rights Means For You 

The Patient Bill of Rights establishes expectations for patients, doctors, nurses, hospital administrators, insurance agents, and everyone else involved in the healthcare process. Though various versions of these privileges exist, each measure touches upon the same overarching themes, including:

  • High-quality hospital care
  • A clean and safe environment
  • Patients having an active role in their healthcare experience
  • Privacy
  • Assistance leaving hospital grounds
  • A transparent claims and billing process

Of all contemporary patient rights measures, the ACA and AHA Bill of Rights remain the two most prominent.

The Affordable Care Act (ACA) Patient Bill of Rights 

President Obama signed the Affordable Care Act into law on March 23, 2010, asserting three primary goals intended to put American consumers back in control of their health coverage and care:

  1. Make affordable health insurance available to more people
  2. Expand Medicaid
  3. Support innovative medical delivery methods designed to lower costs

Furthermore, the ACA-mandated version of the Patient Bill of Rights heavily focuses on insurer-patient relations and preventing insurance companies from driving up medical costs. Nearly all contemporary insurance policies comply with ACA standards, allowing for the realization of the following objectives:

  • Removing insurance company barriers between patients and doctors
  • Stopping insurance companies from limiting necessary care
  • Reviewing suspicious insurer premium increases
  • Moderating how companies spend customer premium dollars
  • Guaranteeing coverage for young adults and people with pre-existing conditions
  • Mandating all large employers to offer split-premium employee health plans
  • Banning lifetime limits and recissions of insurance coverage

Since its implementation, the ACA has proven to reduce hidden healthcare costs, improve the overall health of American citizens, and even boost worker productivity among those with employer-sponsored coverage.

The American Hospital Association (AHA) Patient Bill of Rights 

The AHA Patient Bill of Rights of 1973 aimed to promote mutual respect between patients and providers and demystify the process of medical treatment, diagnosis, and billing. The AHA expanded this document in 1992, further empowering patients and caregivers with 15 specific rights. The most important of these include:

  • The right to fair and respectful care
  • The right to full disclosure surrounding your diagnosis, treatment, and prognosis
  • The right to know the short and long-term costs of recommended treatment
  • The right to refuse care 
  • The right to an advance directive, such as a living will or power of attorney
  • The right to privacy
  • The right to review your medical records and have them explained

In 2003, the AHA Patient Bill of Rights evolved into the Patient Care Partnership, a plain language brochure explaining the rights and responsibilities of patients during a hospital stay. By establishing trust between patients and their medical staff, these documents help the entire healthcare process operate smoothly.

For example, knowing that doctors and hospitals face severe consequences for malpractice and overcharging may help patients feel more secure taking medical advice. Furthermore, knowing they can ask questions about their health plan and make autonomous medical decisions – even when defying a doctor’s recommendations – might lessen patients’ feelings of helplessness in a clinical environment.

Other Notable Patient Protections 

Medical patients have many additional legal protections, including:

  • State laws and Joint Commission accreditation rules requiring informed consent
  • Federal consumer protection laws, such as the No Surprises Act, moderating debt collectors, credit reporting, and predatory billing practices
  • Fraud, waste, and abuse laws preventing medical providers from billing patients for services they did not receive or misusing their identity 

Of these additional mandates, EMTALA and HIPAA regulations present particularly ubiquitous benefits.

Emergency Medical Treatment and Labor Act (EMTALA) 

Initially passed in 1986, the Emergency Medical Treatment and Labor Act (EMTALA) requires all hospitals with emergency departments to treat individuals with an emergency medical condition, regardless of their insurance status or ability to pay. In doing so, all emergency rooms accepting Medicare reimbursement must adhere to the following responsibilities:

  1. Provide all prospective patients with a medical screening examination (MSE) to determine the status of their condition
  2. Stabilize any patient determined by their MSE to require emergency care 
  3. Transfer or accept emergency patients to or from other healthcare facilities as appropriate

EMTALA violations can lead to termination of a hospital’s Medicare contract, fines exceeding $100,000, and even civil lawsuits.

Health Insurance Portability and Accountability Act (HIPAA) 

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 established national standards preventing healthcare providers from disclosing sensitive health information without a patient’s knowledge or consent. Specifically, the HIPAA Privacy Rule instructs healthcare providers and insurance companies on how to use, share, and disclose an individual’s protected health information (PHI).

As digital sharing and high-speed information transfers have become critical to promoting high-quality healthcare, HIPAA has become even more relevant in protecting public well-being. In conjunction with the Privacy Rule, the HIPAA Security Rule protects a patient’s electronic protected health information (E-PHI). Patients can report suspected HIPAA violations to the HSS Office for Civil Rights and advocate for monetary or criminal penalties.

How To Take Charge of Your Care 

If you believe a healthcare institution has violated your patient rights or you want to prevent such an event from occurring, employ the following strategies:

  • Read through your Patient Care Partnership brochure to fully understand what to expect and what you can advocate for while in hospital custody
  • Ask questions about your treatment plan and define personal boundaries with medical staff
  • Keep track of your bills to ensure hospitals and insurance companies have not charged you erroneously
  • Request a new doctor or transfer to a different hospital
  • Share grievances and complaints with a hospital’s on-site patient advocate
  • If the on-site advocate has a pro-hospital bias, find and contact an independent patient advocate
  • File complaints with your state’s Department of Health Services or the HSS Office of Civil Rights
  • Contact the Centers for Medicare and Medicaid Services or any other authority that funds and regulates your hospital
  • Report medical malpractice or professional misconduct to the appropriate state or territorial medical board
  • If all else fails, contact an attorney and prepare for legal action

All in All 

All medical patients have mandated rights under the ACA, AHA, and other federal and state-level laws preventing over-billing, discriminatory or unethical medical treatments, and predatory insurance practices. Always review your rights online, ask questions, advocate for yourself, and file the necessary complaints before, during, and after your hospital residency to ensure a safe, private, and thorough healthcare experience.

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