Patient's Bill of Rights According to the Affordable Care Act

1
Ban on Discriminating Against Patients with Pre-Existing Conditions

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Health care plans and payers are no longer allowed to discriminate on patients based on pre-existing conditions. A pre-existing condition is any medical condition that was diagnosed prior to the patient receiving his/her current health insurance coverage.  

The Affordable Care Act ensures that all individuals that apply for health coverage will be sold a policy regardless of their medical condition and health insurance companies cannot have pre-existing condition exclusions in the health plan.

2
Ban on Insurance Companies Dropping Coverage

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Health care plans and payers are no longer allowed to drop coverage on a patient based on an unintentional mistake on his/her health insurance application.  Health insurance plans can rescind a health care policy only due to an act of fraud such as intentionally and willfully omitting or misrepresenting information on an application for coverage.  

The Affordable Care Act ensures that an insurer can only cancel a health care policy if the individual stops paying premiums, stops offering insurance or leaves the insurance market area, the individual moves out of the insurance market area, or insurance is provided through an association and membership in the association is canceled.

3
Ban on Insurance Companies Limiting Coverage

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Health care plans and payers are no longer allowed to limit coverage due to chronic or serious illness such as an annual or lifetime spending limits for patients that require critical care.  

The Affordable Care Act ensures that an insurer cannot limit a patients treatment to a certain dollar amount leaving them without an adequate means of paying for essential medical treatment. 

4
Ban on Insurance Companies Limiting Choice of Doctors

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Health care plans and payers are no longer allowed to dictate what doctor a patient can seek treatment from. If the plan requires the selection of a PCP (primary care physician), the patient can select their own physician within the health insurance network of providers. This also includes the freedom to select a pediatrician and OB/GYN of the the patient's choice.

The Affordable Care Act ensures that an insurer cannot select a PCP on behalf of a patient or require prior approval, authorization or a referral to visit an OB/GYN.

5
Ban on Insurance Companies Restricting Emergency Room Care

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Health care plans and payers are no longer allowed to require prior authorization before seeking emergency treatment.  Patients exhibiting severe symptoms should seek immediate attention from the nearest emergency room without regard or concern for financial matters.

The Affordable Care Act ensures that an insurer cannot require prior authorization for emergency services, deny out-of-network emergency services, charge higher copays or coinsurance for out-of-network emergency services, or limit coverage for out-of-network emergency services.

6
The Right to Appeal

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Health care plans and payers are no longer allowed to prevent individuals from filing an appeal when the individual disagrees with the health care plan's decision to deny payment or reduce payment for any reason.

The Affordable Care Act ensures that an insurer must follow the appeal process as established by the federal government.

7
Covering Young Adults on Parent’s Plan

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Health care plans and payers are no longer allowed to suspend dependent children coverage under the age of 26 for those that qualify. Young adults are now allowed to stay on their parents insurance for an extended period of time.

The Affordable Care Act ensures that an insurer must continue to provide coverage to dependent children until the age 26.

8
Covering Preventive Care With No Cost

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Health care plans and payers are no longer allowed to charge copays, coinsurance or deductibles for certain preventative items of services. See a full list of recommended services.​​

The Affordable Care Act ensures that an insurer cannot require cost-sharing for recommended preventative care such as blood pressure screening, tobacco screening, cancer screening, hearing and vision screening, and immunizations.