HLT 162 - Selected Topics in Health Science : Hiller: Patient/Resident Rights

A synopis of Patient RIghts from Massachusetts Department of Education- Centralized Clinical Placement Online Orientation.  
Click on the link to see the concepts further defined.

Patient Rights

Federal and state laws provide for specific patients' and residents' rights. All patients and residents have rights and are informed of these rights upon health care organization admission. They are known as the Patient's Bill of Rights. Many health care organizations have patient advocates who can help patients/residents if they have problems. Many states have an ombudsman office for problems with long term care. The following summarizes key areas of federal laws and the MA/ME/NH Patients' and Residents' Rights.

The Right to Information Disclosure.
Patients/Residents have the right to receive accurate, easily understood information to assist them in making informed decisions about their health plans, facilities and professionals.

The Right to Choose.
Patients/Residents have the right to choose health care providers who can give them high-quality health care when they need it.

The Right to Access Emergency Services.
Patients/Residents have the right to access emergency health services when and where the need arises.

The Right to Participation in Treatment Decisions.
Patients/Residents have the right to know their treatment options and take part in decisions about their care.

The Right to Care and Treatment.
Patients/Residents have the right to expect that health care organizations will give the necessary health services to the best of their ability. Treatments, referral, or transfer may be recommended.

The Right to Respect and Non-Discrimination.
Patients/Residents have the right to considerate, respectful care from their doctors, health plan representatives, and other health care providers that does not discriminate against them.

The Right to Privacy and Confidentiality.
Patients/Residents have the right to privacy and confidentiality of health information.

The Right to Speedy Complaint Resolution.
Patients/Residents have the right to a fair, fast, and objective review for  resolving differences.

The Right to Safety.
Patients/Residents have the right to expect reasonable safety insofar as the health care facility practices and environments are concerned.

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What is the Patient’s Bill of Rights?

There’s more than one Patient’s Bill of Rights

In the early 1970’s 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 there’s more than one version of the Patient’s 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.

Patient’s rights and health insurance: the Affordable Care Act

In 2010, a new Patient’s 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 parent’s policy until age 26 if they meet certain requirements.
• You’re 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 doesn’t 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 don’t 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 don’t have to follow all of the new rules as long as they keep an old plan in effect. You’ll need to check your plan’s 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 you’ll still have to check with each plan to find out exactly what they do and don’t do.

If you would like to read more about these rights, you can visit www.healthcare.gov/how-does-the-health-care-law-protect-me.

Source: American Cancer Society