Patient's Bill of Rights - Case Study Example

? PATIENT'S BILL OF RIGHTS LINK http healthcarereform.procon.org/sourcefiles/at_risk_pre_existing_conditions_could_effect_1_in_2_americans.pdf PATIENT’S BILL OF RIGHTS Everyone is entitled to basic human rights that are enshrined in the constitution. John Q Public is not an exception to such a case. The state should not entertain infringement on his rights by any party, and severe actions should be taken against the party that encroaches on these inalienable rights. John suffers from diabetes, a condition that health insurance companies consider preexistent prior to his application for a health insurance policy. He claims that the state has denied him the right to proper medical attention due to his health ramifications. The bureaucratic insurance companies have bottlenecked his efforts to access full medical cover owing to diabetic condition. The pre-existent condition suffered by John places him at a disadvantageous position in the social arena. His condition limit his ability to access affordable health insurance if he becomes self-employed, secures a job in a company that does not proffer coverage, or experience a life changing circumstances like retirement, divorce or relocation to a different state (HHS, 2011). That is when the Affordable Care Act comes to his aid. If it were, at any rate, rescinded, John would suffer a circumstantial health blow dealt by nature in the event of sickness. The Pre-Existing Condition Insurance Plan provides John with protection against egregious insurance companies’ discriminative health-oriented policies. Regulations found in the act have undergone revision to provide that insurance companies should not use health status as the basis of ascertaining consumers eligibility, benefits and premiums; individual and small businesses have a wide range of private insurance plans to choose from through Exchanges in their respective states; and ban on annual dollar limits on coverage in the group, and new individual market plans coupled with coverage of critical benefits and out-of-pocket spending limitations. In addition, insurers are not allowed to limit lifetime coverage to a fixed dollar amount, rescind your coverage on the grounds of a mistake on application, deny coverage to a child due for pre-existing condition, and Pre-Existing Condition Insurance Plan have been set up to cater for those uninsured but have a pre-existing condition (HealthCare.gov, 2010). Despite this preexistent health condition, the interim Affordable Care Act that the congress amended on June 22, 2010 caters for John’s health issue.. The Act provides for the safeguard of his health by enshrining health related regulations. It contains the Pre-Existing condition Insurance Plan that offers protection for John. It avails health coverage to US citizens. John stands to benefit from what the plan has to offer as meticulously elaborated in the plan. The benefits include primary and specialty care, hospital care, prescription drugs and treatment of pre-existing condition. Also, the program charge normal premiums irrespective of the medical condition and income are not the ground for legibility (HealthCare.gov, 2010). The State have several Federal-run programs that provide a legal framework geared towards addressing John’s health dilemma. The U.S. Department of Health and Human Services effects the Pre-Existing Condition Insurance Plan. However, there are laid-down requirements that John must comply with for health coverage. They include documents like a letter from a health practitioner indicating his name, his medical condition, name of the practitioner, license number, state of licensure, and signature; denial letter from an insurance company licensed in John’s state; the rejected offer of the insurance coverage that says John’s condition won’t be covered in the event of acceptance of the offer and/or the premium get overcharged because he was underage or he lived in Massachusetts or Vermont. All the above documents should be dated within a one-year period (HealthCare.gov, 2010). In the event that the insurers deny John health coverage on the basis of lack of full compliance with the insurance plan, the regulations entitle him to an appeal. It is imperative that John cites the reason and any other information indicated in the denial to weigh the option of appealing the decision. The administrator is required to inform John on the right channels to use in the appeal process, and number of days granted for your appeal. It is advisable that John includes any relevant additional information or medical evidence to support his claim or information required by the plan’s procedure. He should ensure that he delivers the information to the specified person and submit within the confines of the permitted span (U.S. Department of Labor, 2011). If the insurer meets his appeal with denial, John should file a suit in court to obtain his benefits. John’s case was an eye-opener. It provided an opening through which we can afford to look into the structural foundation of the administrative law systems. Health administrative agencies have been in existence for a long period. For example, such agencies include the U.S Department of Health and human sciences. They serve the purpose of creating awareness through media among other means like internet. They provide a platform for consumers to be able to surmount various challenges emanating from their dealings with the insurance companies. For instance, if the insurance company rejects his appeal, John could seek more assistance from one the U.S Department of Health and Human Services. Also, he has the right under ERISA to approach the Department of Labor' Employees for assistance. The Department of Health and Human Services is the principal agency for safeguarding the health of all Americans and providing essential human services, particularly for those who have the least ability to help themselves (Lubkin & Larsen 2012). It works closely with state and local governments (HHS). Administrative agencies have been at the forefront in ensuring that the regulation are put into practice. HHS bear onus of responsibility in furthering Open Government Agenda. The Open Government Agenda fosters collaboration between the government and the people to ensure better results for people. Regulatory agencies form the congress right wing to aid in implementation of its provisions. When the congress passes a given regulation, it delegates the duty of implementation to the agencies. The agencies then embark on the process of effectuation. They carry out the process through county agencies the level of state (Pilzer 2007). This is evident as seen in one of the letters sent to the secretary of Department of Health and Human Services. The companies in the medical field recognize the department as the government authority with the mandate to effect its regulations. The HHS is required to implement or ensure implementation of congress legislation, and it oversees the entire process to the letter(Biotechnology, 2011). Also, one year after the enactment of the Affordable Care Act’s Patient’s Bill of Rights, Department of Health and Human Services issued out a summary report of the achievements of the health reform law (HHS, 2011). It has come to authority’s notice that politicians among other individuals might fall behind the seconding of motions in congress to serve their own interest. The HHS annual appropriation bills clearly state that no fund set aside for the HHS should be channeled towards any activity that is meant to influence the legislation before congress. Members of congress when considering healthcare reform, HHS is not permitted to use its appropriated funds to support its distribution (Kosar, 2010). The HHS intermediates between the public and the insurance companies. They play the role of championing for the rights of the patients and requires the insurers company to strictly adhere to the rules that congress has laid down. It recognizes the fact that every citizen is entitled to health coverage and the HHS devotes itself top overseeing the materialization of regulations. The HHS informs the public of the congress deliberations through advertisements in media, internet and other means. In cases of pandemic, the HHS contains spread of rumors among the public, train spokespersons,develop key messages and materials and discharges other actions to contain the pandemic. The Division of Labour has instituted rules that give the procedure for the client’s denial appeal (HHS). The rules provide that the client, upon appeal denial by insurers, should file a legal suit against the company. To cap it all, John’s case has been catered for in the new regulations meant to curb the insurers undertakings. The congress has passed new regulations that point towards operations of health insurance companies. The new regulations provide for his coverage despite his preexistent condition. Administrative agencies have been vested with powers to see to it that these regulations are effected. These agencies have several undertakings meant to facilitate this process. Thus, every US citizen can afford to live a healthy life without unnecessary medically-oriented ramifications. References About HHS. (n.d.). Retrieved Feb. 23, 2012, from U.S. Department of Health and Human services: http://www.hhs.gov/about/ At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans: | HealthCare.gov:. (2010). Retrieved Feb. 22, 2012, from HealthCare.gov: http://www.healthcare.gov/law/resources/reports/preexisting.html HHS. (n.d.). HHS Pandemic Influenza Plan Supplement 10 Public Health Communications. Kosar, K. (2010). Analysis of the First Year of the Obama Administration: Public Relations and Propaganda Initatives. Public Relations and Propaganda;Restrictions on Executive Agencies , 19.Retrieved on 22nd Feb. 2012 from, . Lubkin & Larsen D. Pamala. (2012). Chronic Illness. London: Jones and Barlett Publishers. Pilzer P.Z. (2007). The New Health Insurance Solution: How To Get Cheaper, Better Coverage Without A Tranditional Employer Plan. New York: John Wiley And Sons. Pre-Existing Condition Insurance Plan (PCIP) | HealthCare.gov:. (2010). Retrieved Feb 2012, from Healthcare.gov: Taking health into your hands.: http://www.healthcare.gov/law/features/choices/pre-existing-condition-insurance-plan/index.html#benefits Services, U. D. (2011, Jan. 18). Can I get coverage despite having a pre-existing condition? Retrieved Feb 22, 2012, from ProCon.org: Health Care Reform: http://healthcarereform.procon.org/view.answers.php?questionID=001462 United States Department of Labour. What You Should Know About Filing Your Health Benefits Claim. (2011). Retrieved Feb. 22, 2012, from: http://www.dol.gov/ebsa/publications/wyskfhbc.html Read More