The Expansion of Patient Rights Under the Affordable Care Act

The trend in health care is increased governmental regulation making it imperative for health care providers and insurers to understand patient rights. The Patient Self Determination Act of 1990 significantly advanced patient rights, while the Affordable Care Act (ACA) has taken this protection to a higher level.

The preservation of the patient's right to a doctor as their provider is one of the significant changes in the health care dynamic. The patient now has an absolute right to be treated by an OB-GYN doctor without a referral from another doctor and may now seek emergency care at a hospital outside the patient's plan network without prior approval from the health plan.

The landscape has also changed for insurance companies that may no longer arbitrarily rescind coverage, and at the same time lifetime limits on coverage no longer apply and annual dollar limits will be eliminated over a three (3) year period. The insurance carrier is now required to publically justify any unreasonable rate hikes while at the same time patients are guaranteed the right to appeal the denial of a payment by an insurance company. Informed consent and clear explanations of all treatment options is the patient's right in that the theme of the ACA is to provide the patient with care that exceeds the professional standard, permit them to actively participate in their health care decisions and to be free from abuse.

The changing landscape makes it imperative for the health care provider and insurer to do more than simply permit patients to exercise their rights - they must now protect and promote these rights as well. The new standards have made it important for providers to have a well-drafted and comprehensive "Patient Bill of Rights." For more information on this important issue, contact Attorney Sally McDonald or Managing Partner Gary Pannone at 401.824.5100. We welcome your comments, questions and suggestions.


Source: Pozgar, George D., "Patient Care Case Law: Ethics, Regulation and Compliance," Jones & Bartlett Learning, at p. 67-113 (2003).

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