To encourage consumers to be smart and informed about choosing their healthcare, and to bring a degree of fairness to the marketplace, Consumer Reports believes patients must be guaranteed the following basic, common-sense rights. This 12-item Bill of Rights builds on a list of nine recently proposed by Elisabeth Rosenthal, M.D., author of “An American Sickness” (Penguin Books, 2018) and editor-in-chief of Kaiser Health News.

Patients Should Have the Right to . . .

Easy access to a clear statement of what’s covered by your health plan and what’s not.
Federal law already requires this—in a standardized format known as the Summary of Benefits and Coverage, or SBC—but the document is often hard to find. And the growth of high-deductible, short-term, and other limited benefit plans makes it especially vital for consumers to know in advance what charges won’t be covered.

An itemized and accurate bill in plain English.
It should include how much the provider charged, how much the insurer is paying, and how much the patient owes. If the insurer isn’t paying for something, the bill should clearly explain why. And no obscure abbreviations.

Never receive a surprise out-of-network bill.
Patients are frequently hit with massive out-of-network charges even after visits to in-network physicians and hospitals. Why ? Providers often staff their facilities with out-of-network doctors and utilize out-of-network imaging and lab services.

Accurate information about your insurance plan’s provider network.
Patients need to be able to rely on print and online digital directories to choose doctors and hospitals. If a provider is mistakenly listed as “in network,” the insurer should cover any extra out-of-network cost. And doctors should be clearly in network or not—no more letting them cherry pick more lucrative procedures, for example.

A stable network.
Consumers sign up for health insurance one year at a time, so networks should stay the same for at least that long. During that time, providers should be removed only in exceptional circumstances, such as malpractice or retirement.

More on Medical Bills

Be informed of conflicts of interest.
Examples: doctors who own a stake in a testing or surgical facility, and hospitals that pay physicians based on how much revenue they generate through procedures or tests.

Be informed in advance about so-called facility fees.
Some providers now charge hundreds, even thousands, of dollars extra for overhead—but don’t tell the patient until after the visit or procedure. These “facility fees” are sometimes covered by insurance and sometimes not. Patients need that information up front.

Be informed of lower-cost options.
Conversations about effective, less expensive procedures and drugs need to be routine and consistent. A 2016 study of 1,800 doctor visits found that cost came up just 30 percent of the time, and doctors offered less expensive options in only half of those cases.

Be assured that a disputed bill will not be sent to a collection agency.
Some providers play hardball by quickly sending unpaid bills to debt collectors, even while a bill is being disputed, which can take months or years. Patients need to be able to question bills without damaging their credit rating—and also have reasonable payment options when a bill swamps their budget.

See a price list for elective procedures.
Reliable estimates, in advance, for nonemergency care would help patients control out-of-pocket spending.

Be clearly informed about, and given access to, free or reduced-price care programs.
Many hospitals operate such programs for patients who can’t afford to pay—often as required by state law or to qualify for tax exemptions. But the programs are often underutilized because patients aren’t aware of them, and programs can have opaque eligibility criteria and complex application processes.

No surprise charges for supposedly free preventive services.
Annual wellness visits are free. But if the provider performs any other service while you’re there, or answers specific questions, the visit could be recategorized as “diagnostic” and trigger charges. Providers, insurers, and the federal government should ensure that consumers get the free preventive services they’re entitled to.

Editor's Note: This article also appeared in the September 2018 issue of Consumer Reports magazine.