The Right to Information About Quality

You must be able to receive accurate, easy-to-understand information about health plans, healthcare professionals, and hospitals and clinics so that you can choose your care wisely.

That means that you should:

• Have the details of your health plan spelled out clearly and precisely
• Be able to quickly learn about the education, licensure, experience, and any bad marks on the professional records of doctors and others healthcare providers
• Be able to quickly acquire a variety of statistics on hospitals and clinics, including how often certain procedures have been performed there, comparisons between them and other institutions, and how to lodge complaints against them

The Right to Choose a Healthcare Provider

All health plans must offer you a wide enough range of coverage options so that you don't have to wait for any services you need. Women must have a choice of gynecological and obstetrical professionals, and anyone who needs the services of a specialist must be able to get them. If plans do not fulfill these basic provisions, you have the right to seek care outside of the plan at no additional cost.

Furthermore, if you have a chronic or disabling condition and your health plan terminates your provider's contract, you may be able to continuing seeing your provider for up to 90, unless the termination is for a cause. If you are in the second or third trimester of pregnancy, you may continue seeing your OB/GYN until the end of your postpartum care.

The Right to Emergency Services

You should not need permission ahead of time to use emergency services if you have symptoms that a "prudent layperson"—meaning a reasonable person—would consider an emergency. While this stipulation may seem somewhat unclear, it is meant to prevent people from abusing the convenience of emergency rooms rather than scheduling appointments in a doctor’s office. This right also protects patients by ensuring they aren't held back from using emergency services by health plans attempting to save money.

Health plans should tell you where emergency services near you are located, and what you will be expected to pay when you use them. You should not be penalized if the nearest facilities available to you during an emergency are not in your network. And people who work in emergency departments should get in touch with your health plan as soon as possible.

It is your responsibility to make appointments before emergencies arise whenever possible, even if that means you have to take time off from work or find transportation to destinations farther away than the closest hospital. Your health plans should provide easy access to healthcare professionals and provide adequate opportunity for care.

However, if you have good reason to think you are in trouble and shouldn't wait to see a doctor, you must be permitted to use emergency services.

The Right to Make Decisions

You must be given all the information you need to make decisions about your healthcare. No one else can make those decisions for you—except under the following conditions:

• If you are unable to make decisions (due to physical or mental health reasons) and you have legally handed over that right to a designated family member or friend
• If you are the responsibility of a person assigned to you by a court

Doctors and other healthcare professionals may recommend a particular course of action, but you must be informed of all other options and be given the opportunity to carefully consider those options before proceeding.

You have the right to refuse treatment. To make sure you can exercise that right, it is best to spell out ahead of time what kinds of treatments you want or don't want in case you become extremely ill and are unable to speak for yourself. A "living will" is one way to do that. For more information on living wills and related topics, see the article in this series entitled End of Life Care.

The Right to Respect 

You must be treated with respect and good manners, and may not be discriminated against for any reason, including sex, age, race, national origin, religion, sexual orientation, or disability.

Doctors should see you as soon as possible, and not keep you waiting any longer than is necessary. Once they see you, they should attempt to give you all the time you need to understand your diagnoses and explain your treatment options.

You must, in turn, treat healthcare professionals appropriately, and do what you can to promote mutual respect.

The Right to Confidentiality 

Healthcare professionals, insurers, and suppliers may not discuss your health history with employers or anyone else unless you give them permission to, except if the exchange of information is necessary for your care, and in some cases where the law or public health are concerned. For more information on your rights to privacy, see the article in this series entitled HIPAA: Your Right to Health Care and Privacy.

You have the right to access any and all of your healthcare records. This gives you the responsibility to know what is in those records, and to find out if anyone has had unauthorized access to them.

The Right to Complain 

You have the right to report and seek quick resolutions to any problems you have with your healthcare. Matters that might be of concern to you include billing, denied treatment, waiting times, how you have been treated, and lack of services.

All health plans, providers, and related institutions should have internal systems in place to handle both complaints and appeals. The process for these should be easy to understand and participate in, and all rules should be made known to you.

If you need external help, you can turn to state licensing agents and other protective agencies set up by each state.