Even if you didn’t know it, you have rights as a patient. In 1998, the U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry adopted a Consumer Bill of Rights and Responsibilities, which is summarized in this Straight, No Chaser. These rights apply universally to plans offered to federal employees and largely by health insurance plans and facilities.
Access to emergency services
If you have any health-related consideration that makes you believe your health is in danger, you have the right to be screened and stabilized using emergency services such as your local ER. You should be able to use these services whenever and wherever you need them, even if they’re out of your network, without needing to wait for authorization and without fear of any financial penalty from your insurance provider.
Choice of providers and plans
You have the right to choose healthcare providers who can give you high-quality health care when you need it.
Complaints and appeals
You have the right to a fair, fast and unbiased review of any complaint you have against your health plan, doctors, hospitals or other healthcare personnel. These complaints may include excessive waiting times, hours of operation, the actions of healthcare personnel, and/or the adequacy of health care facilities.
Confidentiality (privacy) of health information
You have the right to talk privately with healthcare providers and have your healthcare 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 it’s not correct, relevant or complete.
Information for patients
You have the right to accurate and easy-to-understand information about your health plan, healthcare professionals, and healthcare facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, help should be given so you can make informed healthcare decisions.
Respect and non-discrimination
You have a right to considerate, respectful care from your doctors, health plan representatives and other healthcare 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.
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.
In a healthcare system that protects consumers’ or patients’ rights, patients have certain responsibilities. For instance, patients must tell their healthcare 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 healthcare providers if they do not completely understand health information and/or instructions they’ve 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 healthcare system.
Patients are also expected to do things like treat healthcare workers and other patients with respect, try to pay their medical bills, and follow the rules and benefits of their health plan coverage.
Knowing your rights is an important way to ensure you are receiving the best care possible. Take the time to learn these rights and use them to your advantage.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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