Key takeaways:
A half century ago, the American Hospital Association (AHA) published a Patient’s Bill of Rights to list the expectations consumers should have for medical treatment at a hospital and its cost. The goal was to protect people in the U.S. and provide the best care possible.
In 2003, the AHA Patient’s Bill of Rights evolved into a document called The Patient Care Partnership that outlined expectations, rights, and responsibilities for hospital care.
The federal government, state governments, and health plans have created their own bills of rights to further protect people receiving healthcare.
The American Hospital Association (AHA) first adopted its Patient’s Bill of Rights in 1973 and revised the document in 1992. The AHA published these guidelines to ensure hospitals treated patients fairly. They were also designed to encourage patients to participate in their healthcare, and they suggested how patients could communicate grievances. Hospitals today continue to enforce these rights.
In 2003, the AHA updated this guidance to a more concise list of expectations, rights, and responsibilities called The Patient Care Partnership.
Other organizations have developed their own patient bills of rights. The federal government, for instance, has a set of protections for health coverage under the Affordable Care Act (ACA). Federal consumer agencies and many state governments also have mandates in place to protect patients.
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For this post, we’ll focus on the AHA’s Patient’s Bill of Rights and other laws that protect patients.
What is in the AHA’s Patient’s Bill of Rights?
Initially published in 1973, the AHA’s Patient’s Bill of Rights were guarantees for anyone seeking care in a U.S. hospital. The declaration aimed to promote respect for patients and providers as well as open dialogue about diagnosis, treatment, and fees.
The Patient’s Bill of Rights was designed to empower patients and caregivers. For example, it gives you the right to ask to speak to the patient advocate or ombudsman if you believe a physician or other provider has violated your rights.
The Patient’s Bill of Rights was revised in 1992 to include 15 rights:
You have the right to be treated fairly and respectfully.
You have the right to get information you can understand about your diagnosis, treatment, and prognosis from your healthcare provider.
You have the right to discuss and ask for information about specific procedures and treatments, their risks, and the time you will spend recovering. You also have the right to discuss other care options. You may lose this right if you’re in the middle of an emergency and don’t have the ability to make sound decisions.
You have the right to know the identities of all of your healthcare providers, including students, residents, and other trainees.
You have the right to know how much care may cost at the time of treatment and long term.
You have the right to make decisions about your care before and during treatment and the right to refuse care. The hospital must inform you of the medical consequences of refusing treatment. You also have the right to other treatments provided by the hospital and the right to transfer to another hospital.
You have the right to have an advance directive, such as a living will or a power of attorney for healthcare. A hospital has the right to ask for your advance directive, put it in your file, and honor its intent.
You have the right to privacy in medical exams, case discussions, consultations, and treatments.
You have the right to expect that your communication and records are treated as confidential by the hospital, except as the law permits and requires in cases of suspected abuse or public health hazards. If the hospital releases your information to another medical facility, you have the right to expect the hospital to ask the medical facility to keep your records confidential.
You have the right to review your medical records and to have them explained or interpreted, except when restricted by law.
You have the right to expect that a hospital will respond reasonably to your requests for care and services or transfer you to another facility that has accepted a transfer request. You should also expect information and explanation about the risks, benefits, and alternatives to a transfer.
You have the right to ask and be informed of any business relationships between the hospital and educational institutions, other healthcare providers, or payers that may influence your care and treatment.
You have the right to consent to or decline to participate in research studies and to have the studies fully explained before you give your consent. If you decide not to participate in research, you’re still entitled to the most effective care that the hospital can provide.
You have the right to expect reasonable continuity of care and to be informed of other care options when hospital care is no longer appropriate.
You have the right to be informed of hospital policies and practices related to patient care, treatment, and responsibilities. You also have the right to know who you can contact to resolve disputes, grievances, and conflicts. And you have the right to know what the hospital will charge for services and their payment methods.
By 2003, the Patient’s Bill of Rights had evolved to a new 21st century document called The Patient Care Partnership. We’ll discuss that more in the next section.
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What is The Patient Care Partnership?
For the last 2 decades, the AHA has discussed patient rights in a short brochure called The Patient Care Partnership. This document outlines six simple expectations for hospital care:
High-quality hospital care
A clean and safe environment
Your involvement in your care
Protection of your privacy
Help when leaving the hospital
Help with your billing claims
Are there laws that protect patients?
One of the most important patient rights is informed consent. This means that patients have the right to know the risks, benefits, and alternatives to a procedure or treatment — and physicians and other providers have a legal and ethical obligation to provide this information.
Patients also have rights to information about their health status. They also have the right to ask questions about treatment options and make their own decisions — even if it goes against a provider’s recommendation.
Other federal laws that protect patients include the following.
The Emergency Medical Treatment and Labor Act
The Emergency Medical Treatment and Labor Act, known as EMTALA, requires hospitals with dedicated emergency departments to provide medical care to anyone who requests access regardless of their ability to pay or their health insurance status.
Consumer protection laws
You have rights as a consumer of healthcare services that are enforced by the Federal Trade Commission and the Consumer Financial Protect Bureau. This applies to debt collection and fair credit reporting.
The No Surprises Act, which went into effect in 2022, prevents people with private insurance from receiving out-of-network charges from hospitals and outpatient surgery centers.
Fraud, waste, and abuse laws
There are many fraud, waste, and abuse laws designed to protect patients. These laws are aimed at preventing providers from billing for services that you didn’t receive or using your identity to treat someone else.
Upcoding is an example of an illegal billing practice that often goes undetected. It’s when a provider uses the wrong codes and sends your health plan false claims or gives you a fraudulent bill as a cash payer. You’re the victim of upcoding if you get billed for:
Treatment you didn’t get
More expensive treatment than what you were given
Treatment you didn’t need
A service that was included within a larger scope of a service
Treatment you got from an unqualified or underqualified employee
Health Insurance Portability and Accountability Act
Congress passed the Health Insurance Portability and Accountability Act (known as HIPAA) in 1996 to protect patient information while ensuring consumers had access to their health information, including medical records. HIPAA also gives you the right to change incorrect information on your records and to learn who else has seen your records besides your provider.
Pre-existing conditions under the Affordable Care Act
The ACA protects you from being denied health insurance or charged more if you have a pre-existing condition.
What can I do if I believe my rights have been violated?
If you believe your rights have been violated or that you have received substandard care, one place to start is with the hospital’s patient advocate — sometimes called a patient representative. Many hospitals have patient advocates who help handle complaints and grievances.
A patient advocate can help you navigate the complaint process, but keep in mind that they are hospital employees. Independent patient advocates can be found through groups such as the National Association of Healthcare Advocacy.
You can also file complaints with your state department of health services or with the U.S. Department of Health and Human Services’ Office of Civil Rights. Another option is any authority that funds or regulates the hospital, such as the Centers for Medicare & Medicaid Services (CMS), which monitors hospitals that receive Medicare and Medicaid funding.
You can file a complaint with CMS about provider billing here. If you have a complaint about a physician’s care or unprofessional conduct, you can file a complaint with the appropriate state or territory medical board. Depending on the situation, you can also consult with an attorney.
The bottom line
The American Hospital Association designed the Patient’s Bill of Rights in 1973 to establish expectations for people who give and receive care in hospitals. The Patient’s Bill of Rights evolved into The Patient Care Partnership in 2003. These rights, along with laws enacted by the federal government and states, help protect patients from unlawful practices, unnecessary treatments, and overbilling. You have the right to ask questions and to file complaints if you believe your rights have been violated.
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References
American Hospital Association. (n.d.). The Patient Care Partnership.
American Hospital Association. (2003). The Patient Care Partnership: Understanding expectations, rights and responsibilities.
American Patient Rights Association. (n.d.). AHA Patient’s Bill of Rights.
Centers for Disease Control and Prevention. (2022). Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Centers for Medicare & Medicaid Services. (n.d.). You can submit a complaint with us: When your provider or insurer might not be following the rules.
Centers for Medicare & Medicaid Services. (2021). Medicare fraud & abuse: Prevent, detect, report.
Centers for Medicare & Medicaid Services. (2023). Emergency Medical Treatment & Labor Act (EMTALA).
Chen, Z. X., et al. (2003). Recommendations to protect patients and health care practices from Medicare and Medicaid fraud. Journal of the American Pharmacists Association.
DocInfo. (n.d.). Reporting a doctor for unprofessional conduct. Federation of State Medical Boards of the United States Inc.
HealthCare.gov. (n.d.). Health insurance rights & protections.
National Association of Healthcare Advocacy. (n.d.). Directory of advocates.
Shah, P., et al. (2023). Informed consent. StatPearls.
U.S. Department of Health and Human Services. (2023). Can I get coverage if I have a pre-existing condition?
U.S. Department of Health and Human Services Office for Civil Rights. (n.d.). Complaint portal.
