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Understanding the health reform Patient's Bill of Rights Posted: December 12th, 2010

By Maryalene LaPonsie

On March 23, 2010, the Patient Protection and Affordable Care Act (PPACA) was signed into law. The comprehensive legislation touched on everything from access to insurance to nutrition initiatives to tax policy. However, at its core, the PPACA has the goal of giving consumers greater control over their health care and health insurance. On September 23, 2010, a Patient's Bill of Rights takes effect to give you greater freedom to decide when and where you receive medical treatment.

How the Patient's Bill of Rights affects your medical insurance

The Patient's Bill of Rights is not a specific law enacted by Congress. Instead, it is a set of rules created by the Department of Health and Human Services (HHS) to regulate medical insurance companies. Congress authorized HHS to create the rules when it passed the PPACA.

The main provisions of the Patient's Bill of Rights prohibit the following:

  • Pre-existing condition exclusions for minors: Prior to the Patient's Bill of Rights, a health insurance company could limit coverage of a pre-existing condition. For example, if a child had cancer, the company could legally opt-out of paying for any cancer-related treatments for 12 months. In addition, individual insurance plans could deny coverage for families with children who have pre-existing conditions. With the Patient's Bill of Rights, these denials and exclusions are illegal. Similar protections will be extended to adults in 2014.
  • Health insurance policy rescissions: In the past, some health insurance companies would arbitrarily cancel the policies of families faced with a serious illness. The Patient's Bill of Rights states that a medical insurance company can only revoke a policy in the event of fraud or if it believes facts on the insurance application were intentionally misrepresented. Even then, the company must give a 30 day notice to allow time for the policyholder to appeal the decision.
  • Annual and lifetime coverage limits: The Patient's Bill of Rights prohibits medical insurance companies from limiting the amount of coverage they provide either for the year or for the lifetime of the policy. The prohibition on lifetime limits goes into effect for all policies issued or renewed after September 23, 2010.
  • Limitations on physician choices: Under the new rules, parents can choose any participating pediatrician as their child's primary care doctor. In addition, women can no longer be required to get a referral to see an OB/GYN. Finally, a health insurance company can no longer require higher co-pays or prior approval before using an out-of-network hospital for emergency care; welcome news for anyone who has found themselves in need of medical attention while away from home.

In addition, the provisions of the Patient's Bill of Rights are intended to complement other aspects of the PPACA. These include the recently rolled out high-risk pools for adults with pre-existing conditions, as well as federal aid to states to assist them in reviewing the appropriateness of medical insurance premium hikes.