Your Health and the Law: Patient Rights Basics

While health care is fundamentally a private matter between patients and their care providers, it intersects with the law in many ways. For instance, health care programs available to low-income and other vulnerable Americans were created through federal laws.

Similarly, health savings accounts that allow patients to use pre-tax income for health care expenses came about through a change in the tax code. Health care and medicine also involve civil law, as in lawsuits targeting the improper marketing of prescription drugs.

This article addresses the many ways health care is impacted by the law. Find a brief overview of doctor shopping laws, the Children’s Health Insurance Program (CHIP), single-payer health care, and more.

If you have a healthcare law issue or concerns about a violation, a local attorney can explain your rights and legal options.

Dangerous Drugs and Doctor Shopping

Certain drugs, including many prescription medications, are categorized as “controlled substances” if they have the potential to be habit-forming. These include opioids such as OxyContin and tranquilizers such as Valium, which often get diverted into the black market or used illicitly.

While those with legitimate substance abuse problems often are given access to treatment instead of incarceration, those convicted of obtaining controlled substances through fraud face criminal consequences, including incarceration. This is referred to as “doctor shopping.”

Similarly, drug makers and distributors that look the other way or otherwise fail to properly protect the public from these drugs also may face criminal charges or civil lawsuits.

Health Savings Accounts

The U.S. tax code allows for the use of pre-tax income for health care expenditures. These health savings accounts (HSAs) are offered through insurance companies, some employers, and most financial institutions. Funds may also be invested.

There are certain limits to what you can pay through your HSA, but unlike flexible savings accounts (FSA), you may roll over your remaining balance at the end of each tax year. Also, you must have a high-deductible health insurance plan as defined by the Internal Revenue Service (IRS) to qualify.

CHIP and Children’s Access to Health Care

The Children’s Health Insurance Program (CHIP) is a federally mandated program administered through the states that covers children in low-income families. Specifically, it’s designed to cover children in households whose income isn’t low enough to qualify for Medicaid, but who don’t earn enough to purchase insurance on the open market.

Depending on how the coverage is procured and the regulations of the particular state, CHIP coverage is either identical (or roughly equivalent) to that provided through most state Medicaid plans.

CHIP application processes, eligibility, and coverage vary by state. A local healthcare attorney can explain available options for your children and explain the coverage they may be eligible for.

Single-Payer Health Care

Health care in the United States is a “multipayer” system — multiple insurance companies and individuals pay for health care services. But most industrialized nations have what is called “single-payer” health care. In these systems, the government is the sole payer for health care services, funded through tax revenue.

Advocates for single-payer health care in the United States often refer to it as “Medicare for all,” since Medicare is in fact a single-payer system but at a much smaller scale.

Informed Consent: You’re in Control of Your Medical Care

Doctors and other medical experts use their expertise to diagnose medical conditions and recommend a treatment plan. However, patients must always remember that the decision to treat — or not — ultimately resides with them. This means that if a patient chooses not to follow a doctor’s advice or refuses treatment, the physician has no authority to force the patient to undergo treatment.

This right extends to taking prescribed medication as well as choosing which medical professional will treat the patient. Finally, patients can decide whether they want to disclose their medical records or keep them private.

See the Patient Bill of Rights and Responsibilities from the U.S. Department of State to learn more.

HIPAA: Your Right to Privacy

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects patients’ right to privacy. Under HIPAA, providers and others can’t share sensitive patient health information without consent, with some exceptions. HIPAA also grants patients the right to inspect, review, and request copies of their medical records.

In general, patients don’t have the right to sue healthcare providers directly for unauthorized disclosures. Instead, patients who have experienced HIPAA violations can file complaints with the U.S. Department of Health and Human Services’ Office for Civil Rights. They can also work with an attorney to explore other legal options under their state’s privacy and confidentiality laws.

Planning Ahead for Your Care

One of the best ways for patients to assert their rights is to plan ahead. In the midst of a medical crisis is not the best time to make important decisions about your health. Fortunately, there are steps you can take to make these decisions before you’re in the hospital or incapacitated.

Once you know how you would like to be treated in the event of an emergency, you can create an advance directive to instruct your doctors about your wishes. These directives are usually binding on healthcare providers.

Have Questions About Medicine and the Law? An Attorney Can Help

The law intersects with health care in several ways, from regulations on what insurance companies must cover to criminal laws prohibiting the unlawful procurement of narcotic painkillers. If you have questions, reach out to a local healthcare lawyer for expert legal advice tailored to your situation.

FindLaw’s healthcare attorney directory can get you started. Select your state or city to review contact and ratings information for local experts. Because some of your state’s laws are relevant, your attorney should be licensed in your state. Your search results will also show important details about prospective attorneys, like ratings and whether they offer free case evaluations.