MEMBER LOGINThe Affordable Care Act (also known as Obamacare) didn’t just seek to make health insurance more affordable to everyone. It also introduced measures to ensure that health care plans provided a minimum standard of coverage, and that certain protections were put in place to make sure patients got the best care possible. Here’s an outline of some of the patient protections under the Act, most of which apply to people with HMO and POS plans.
The right to choose a primary care provider. Studies show that patients who trust their doctors are more likely to stick to a medication schedule and even have lower mortality rates. As a result, the Affordable Care Act considers it important for patients to be able to choose their own primary care provider that participates in their health care plan.
The right to choose a pediatrician for children’s primary care. In the past, parents who wanted their children to see a pediatrician had to get a referral from a primary care doctor. Now, parents can pick a pediatrician to act as the child’s primary care provider—reducing delays parents sometimes face in getting the right care for their children. This is expected to make pediatric care more regular, and improve child health outcomes.
The right for women to access OB/GYN care without a referral. As many as 4,000 lives could be saved every year by boosting the percentage of women who get recommended breast cancer screenings to 90%. To that end, the Affordable Care Act now requires health care insurers to allow women to make OB/GYN appointments without a referral or prior authorization.
The right to access emergency services. Health insurance providers are now required to allow patients to access emergency medical care without referrals or authorization. They must not impose limitations on out-of-network emergency services or impose a cost-sharing requirement on out-of-network emergency services, outside of certain limits. Basically, health insurers can’t impose any limits on benefits for out-of-network emergency services that is more restrictive than the limits they impose on in-network services.
These patient protection provisions aren’t applicable to grandfathered health plans—that is, those that have existed since before March 23, 2010. Grandfathered health plans have to meet their own set of requirements to qualify for exemptions.
These provisions are designed to make care more accessible and remove some of the barriers to patient care—both administrative and financial. Learn more about the provisions—and other stipulations of the Affordable Care Act—by checking out our online continuing education courses here.