20 Health Law Questions Every Patient and Provider Should Know

Patients’ Rights

What is the Health Insurance Portability and Accountability Act (HIPAA)?

HIPAA is a federal law that protects patients’ medical information, ensuring confidentiality and controlling data access.

What are patients’ rights to access medical records?

Patients can access and request copies of their medical records under HIPAA, usually within 30 days of their request.

Also read:

Can a provider refuse to treat a patient?

Yes, but only for non-discriminatory reasons, such as non-emergency cases or conflicts with the provider’s expertise.

What is informed consent in healthcare?

Patients should be fully informed about risks, benefits, and alternatives to treatments and must give voluntary consent before proceeding.

What are a patient’s rights in emergency situations?

Under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals have to stabilize and treat anyone who comes in seeking emergency care regardless of their ability to pay.

Providers’ Responsibilities

What is standard of care in healthcare?

The level of care and skill a reasonably competent provider would provide under similar circumstances, based on current medical practices.

What is medical malpractice?

It is when negligence by a provider causes harm to a patient such as misdiagnosis, surgical mistakes, or errors in medication prescription.

What is a provider’s obligation under HIPAA?

The provider has an obligation to ensure the protection of patients’ information; sharing of data is only limited to authorized persons and breach notification must be made.

What is the duty to warn in healthcare?

Healthcare providers might need to violate patient confidentiality to issue warnings to others of a patient’s potential danger, such as a threat of violence or infectious diseases.

What is a provider’s role in end-of-life care?

Providers have a duty to honor a patient’s advance directives, like living wills or Do Not Resuscitate orders, without failing to provide adequate palliative care.

Health Insurance and Billing

What does the Affordable Care Act (ACA) protect?

The ACA prohibits insurance discrimination based on pre-existing conditions, mandates essential health benefits, and allows young adults to stay on parents’ plans until age 26.

What is balance billing?

Charging patients the difference between what their insurance pays and what the provider charges, which is illegal in some states and under certain plans.

What are a patient’s options if their insurance claim is denied?

Patients can appeal the denial through the insurance company and, if necessary, through external review or legal action.

What is medical necessity in insurance coverage?

Services or treatment should be medically necessary according to the insurer in order to get insured.

What are surprise medical bills?

Unexpected charges from out-of-network providers during emergency or planned procedures, addressed by federal and state laws.

Privacy and Data Security

What is a breach of medical information?

Unauthorized access, use, or disclosure of protected health information (PHI) that compromises patient privacy.

What is telehealth, and how does it affect privacy?

Telehealth enables remote care through digital platforms. Providers have to use secure technologies to meet HIPAA and protect patient data.

Can healthcare providers share patient data without consent?

Only in specific situations, such as public health reporting, law enforcement requests, or emergency care.

Legal and Ethical Issues

What is the False Claims Act in health care?

A federal law that seeks to address fraudulent health care activity, including false billing for unneeded services or overcharging into government programs like Medicare.

What is the purpose of ethics committees in health care?

Ethics committees help mediate disputes, assist with difficult clinical decisions, and ensure that all care is carried out ethically.

These are some of the key questions involved in health law for patients and providers.