KEY THEMES IN THE PATIENTS' BILL OF RIGHTS

• Access to medical care and the protection of the doctor-patient relationship are the key components of the Patients' Bill of Rights.
• Many managed care beneficiaries face obstacles when they try to access health care.  Obstacles range from the refusal to pay for emergency room services without prior approval to restricting your access to specialists.
• The Patients' Bill of Rights mandates that no prior approval is necessary in any situation that a "prudent lay person" would regard as an emergency.
• The Patients' Bill of Rights requires health plans to provide referrals to specialists when necessary and ensures that health plans meet the special needs of children (access to pediatric specialists).
• Some managed care organizations have been charged with interfering in doctors' communications with their patients.

• prohibit "gag clauses" that penalize doctors for referring patients to specialists or discussing costly medical procedures;
• prohibit financial incentives for doctors who restrict patients' access to care;
• prohibit health plans from retaliating against providers who advocate on behalf of their patients in the utilization review or grievance process.
• prohibit health plans from arbitrarily limiting or changing a patient's treatment if that treatment is determined to be medically necessary (consistent with generally accepted principles or professional medical practice).

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