The Patients’ Bill of Rights is a set of eight consumer protections first defined by a 1998 presidential commission: the right to information, choice of providers and plans, access to emergency services, participation in treatment decisions, respect and nondiscrimination, privacy and confidentiality, complaints and appeals, and consumer responsibilities.1UNT Digital Library. Consumer Bill of Rights and Responsibilities Executive Summary There is no single federal statute by that name, but HIPAA, EMTALA, the Affordable Care Act, and the No Surprises Act each enforce pieces of the framework and give patients real remedies when a provider or insurer falls short.
Where the Eight Rights Come From
In 1997, President Clinton appointed the Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Its final report set out eight areas of consumer rights and responsibilities that became known collectively as the Patients’ Bill of Rights.1UNT Digital Library. Consumer Bill of Rights and Responsibilities Executive Summary Congress never passed the package as a single law. Instead, the individual rights are backed by different federal statutes, and understanding which law covers which right tells you where to turn when something goes wrong.
1. The Right to Information
You are entitled to clear, understandable information about your health plan, your providers, and any treatment they recommend. In a clinical setting this shows up as informed consent: your doctor should explain the diagnosis in plain terms, describe the proposed treatment along with realistic alternatives, and lay out the risks before you agree to anything. The specific disclosure rules vary by state, but the underlying principle is universal. You cannot meaningfully agree to a procedure you do not understand.
Informed consent is not a signature on a clipboard. Your provider should walk you through what will happen, what could go wrong, what recovery looks like, and what might happen if you choose a different option or no treatment at all. If you feel rushed, you can ask more questions or take time to think it over. A provider who pressures you to sign without a real explanation is not meeting the standard.
2. The Right to Choose Providers and Plans
Your health plan’s provider network has to be big enough and varied enough that you can actually see someone within a reasonable drive and wait. Federal regulations require marketplace plans to maintain networks “sufficient in number and types of providers, including providers that specialize in mental health and substance use disorder services, to ensure that all services will be accessible without unreasonable delay.”2eCFR. 45 CFR 156.230 – Network Adequacy Standards
Since 2023, marketplace plans on the federal exchange have had to meet specific time and distance standards, and since 2025, appointment wait time standards apply as well. When a plan falls short, the issuer must submit a written justification explaining how it will improve.2eCFR. 45 CFR 156.230 – Network Adequacy Standards If you are shopping for coverage, a lower premium paired with a thin network can leave you without nearby specialists.
3. The Right to Access Emergency Services
When you arrive at a hospital emergency department, the hospital must screen you and stabilize you regardless of your insurance status or ability to pay. That duty comes from the Emergency Medical Treatment and Labor Act, passed in 1986, which applies to every hospital that participates in Medicare and operates an emergency department.3Centers for Medicare and Medicaid Services. Emergency Medical Treatment and Labor Act Because nearly all hospitals participate in Medicare, EMTALA functions as a near-universal rule.
The hospital must perform a medical screening exam to determine whether an emergency condition exists. If it does, staff must provide stabilizing treatment within the hospital’s capability, and they cannot delay screening or treatment to ask about insurance or payment.4Centers for Medicare and Medicaid Services. Certification and Compliance for the Emergency Medical Treatment and Labor Act If the facility cannot stabilize you, it must arrange an appropriate transfer.5U.S. Department of Health and Human Services Office of Inspector General. The Emergency Medical Treatment and Labor Act “Stabilized” has a specific legal meaning: within reasonable medical judgment, your condition is unlikely to materially worsen during transfer or discharge.6Office of the Law Revision Counsel. 42 USC 1395dd – Examination and Treatment for Emergency Medical Conditions
If a hospital turns you away before that threshold or transfers you for financial reasons, you can file a complaint with your state survey agency or through the CMS online complaint form. You can file anonymously.7Centers for Medicare and Medicaid Services. How to File an EMTALA Complaint
4. The Right to Participate in Treatment Decisions
You are entitled to be an active partner in every healthcare decision, and that includes the right to refuse treatment entirely. No one can force you into a procedure you don’t want, and a designated representative such as a parent, guardian, or healthcare agent can speak for you if you’re unable to decide for yourself.
Advance Directives
The Patient Self-Determination Act, effective in 1991, requires every hospital participating in Medicare and Medicaid to inform adult patients at admission of their right to create advance directives under state law.8Indian Health Services. Chapter 26 – Patient Self-Determination and Advance Directives Two documents cover most situations. A living will spells out which treatments you do and don’t want if you can’t communicate, covering choices like mechanical ventilation, tube feeding, and resuscitation. A healthcare power of attorney (sometimes called a healthcare proxy) names a specific person to make medical decisions on your behalf. A living will gives instructions; a healthcare power of attorney gives authority to a trusted person to handle situations your living will didn’t anticipate. Most estate planning attorneys recommend having both.
What Participation Looks Like
Your care team should discuss all realistic treatment options, explain the benefits and risks of each, and give you enough information to make a choice that fits your values. If surgery is recommended, you should understand why a conservative approach won’t work, what happens if you wait, and what recovery involves. A provider presenting one option as the only option, without explaining alternatives, is not meeting this standard.
5. The Right to Respect and Nondiscrimination
Section 1557 of the Affordable Care Act prohibits exclusion from care on the basis of race, color, national origin, sex, age, or disability in any healthcare program that receives federal funding.9Office of the Law Revision Counsel. 42 USC 18116 – Nondiscrimination Because most hospitals and health plans receive some form of federal financial assistance, this rule reaches broadly across the system.
Federal rulemaking has clarified that sex discrimination under Section 1557 includes discrimination based on sexual orientation and gender identity, and that Medicare Part B funding triggers these protections.10Federal Register. Nondiscrimination in Health Programs and Activities A provider receiving any federal healthcare dollars cannot refuse to treat you or give you inferior care because of who you are.
6. The Right to Privacy and Confidentiality
HIPAA gives you control over your health information. Under the Privacy Rule, your medical records cannot be shared without your written permission unless the law specifically allows it, such as for treatment coordination, payment processing, or public health reporting.11HHS.gov. Your Rights Under HIPAA You decide whether your information can be used for marketing.
Accessing and Correcting Your Records
HIPAA gives you a legal right to see and obtain copies of your records from any covered provider or health plan, and to direct that copies be sent to another person or entity of your choice.12Department of Health and Human Services. Individuals Right Under HIPAA to Access Their Health Information If you spot an error, you can request an amendment. The provider must act within 60 days, with one possible 30-day extension if they notify you in writing.13eCFR. 45 CFR 164.526 – Amendment of Protected Health Information A denial must be in writing and must explain the reason. Providers can charge reasonable fees for copies, and state laws may set separate per-page rates for paper records.
When Your Records Are Breached
If a provider or insurer discovers that your unprotected health information was compromised, they must notify you in writing within 60 days. The notice must describe what happened, what information was exposed, what steps you should take, and how to contact the entity.14eCFR. 45 CFR 164.404 – Notification to Individuals
Filing a HIPAA Complaint
To challenge a privacy violation, file a complaint with the HHS Office for Civil Rights within 180 days of when you discovered the problem, though the office can extend that deadline for good cause.15HHS.gov. How to File a Health Information Privacy or Security Complaint You can file online through the OCR Complaint Portal, by email to OCRComplaint@hhs.gov, or by mail. The entity cannot retaliate against you for filing.
7. The Right to File Complaints and Appeals
When a health plan denies a claim or refuses to cover treatment, federal law guarantees a two-stage appeal. The plan must first offer an internal appeals process where you can submit evidence, review your file, and continue receiving coverage while the appeal is pending. The plan must also notify you, in a language you can understand, of both the internal and external review options available.16Office of the Law Revision Counsel. 42 USC 300gg-19 – Appeals Process
If the internal appeal doesn’t resolve the issue, you can request an external review by an independent third party with no financial relationship to your insurer. File this request in writing within four months of the final internal denial. Standard external reviews must be decided within 45 days. If the situation is medically urgent, you can request an expedited review, which must be completed within 72 hours. Under the HHS-administered federal process the review costs you nothing; otherwise the fee is capped at $25.17HealthCare.gov. External Review The external reviewer’s decision is binding on the plan. To file under the federal process, visit externalappeal.cms.gov or call 1-888-866-6205.
8. Consumer Responsibilities
The commission framed the eighth category not as a right but as the other side of the bargain. Effective care depends on your participation. That means giving your care team an accurate and complete health history, including medications, allergies, and prior surgeries; following agreed-upon treatment plans, or honestly telling your provider when you can’t or won’t; and asking questions when something doesn’t make sense rather than nodding along and guessing later. A doctor cannot manage your diabetes well if you don’t mention what another provider prescribed. A surgeon cannot anticipate complications from an allergy you forgot to disclose.
Surprise Billing Protections Under the No Surprises Act
The No Surprises Act, effective January 1, 2022, is the newest major addition to patient rights. Before this law, patients routinely received large bills from out-of-network providers they never chose, such as an anesthesiologist at an in-network hospital. The law addresses this in two ways: it bans surprise balance billing in specific situations, and it gives uninsured patients the right to a cost estimate before treatment.
Balance Billing Protections
The law prohibits out-of-network providers from balance billing you for most emergency services, non-emergency services provided by out-of-network providers at in-network hospitals and ambulatory surgical centers, and out-of-network air ambulance services.18Office of the Law Revision Counsel. 42 USC 300gg-111 – Preventing Surprise Medical Bills Your cost-sharing cannot exceed what you would pay in-network, and those payments count toward your in-network deductible and out-of-pocket maximum.19U.S. Department of Labor. Avoid Surprise Healthcare Expenses – How the No Surprises Act Can Protect You
There is one situation in which you can waive these protections. For certain scheduled non-emergency services at an in-network facility, an out-of-network provider can ask you to sign a written consent to receive balance-billed care after giving you advance notice. The waiver is never permitted for ancillary services like anesthesiology, pathology, or radiology.19U.S. Department of Labor. Avoid Surprise Healthcare Expenses – How the No Surprises Act Can Protect You
Good Faith Estimates for Uninsured and Self-Pay Patients
If you don’t have insurance or choose not to use it, providers must give you a written good faith estimate of expected charges before your appointment. The estimate must be itemized by provider, written in plain language, and delivered within specific timeframes: within one business day of scheduling if the appointment is at least three business days out, or within three business days if the appointment is 10 or more business days away. You can also request an estimate at any time.20eCFR. 45 CFR 149.610 – Requirements for Good Faith Estimates for Uninsured or Self-Pay Individuals
If your final bill exceeds the estimate by $400 or more, you can dispute it through a federal patient-provider dispute resolution process. You will need your estimate, your bill, and a $25 nonrefundable administrative fee. An independent reviewer evaluates the dispute, and while it is pending the provider cannot send the bill to collections or impose late fees.21Centers for Medicare and Medicaid Services. Dispute a Medical Bill If the reviewer rules in your favor, the $25 fee is deducted from what you owe. You must start the dispute within 120 days of receiving the bill.