Know Your Rights

State and federal laws protect your rights. When you sign up for a health plan and/or if you have problems getting care through your health plan, it is important to know your rights.

Below are some basic health care rights. To find out more about the specific rights in your state, and how you can file a complaint, visit the state resource page.

Health Plan Coverage Information

You have a right to understand what health services your health plan covers and what it does not. Contact your health plan’s member services department to get information about what your plan does and does not include.

Access to Medical Records

You have a right to see and review all of your health care records. Your provider may charge a fee for copies of your records. Most practices or facilities will ask you to fill out a form to request your medical records. This request form can usually be collected at the office or delivered by fax, postal service, or email.

A provider cannot deny you a copy of your records because you have not paid for the services you have received. However, a provider may charge for the reasonable costs for copying and mailing the records. The provider cannot charge you a fee for the time it took to search for or retrieve your records.

Generally, the first 20 pages of a paper version of a medical record may cost approximately $1 per page. Each additional page may cost between 10 cents to 80 cents per page. Special copies, like imaging tests and biopsy slides, may cost between $10-$120 per slide or page of film.

Privacy

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) you have the right to keep your health care information and records private. If you believe that a HIPAA-covered entity or its business associate violated your (or someone else’s) health information privacy rights or committed another violation of the Privacy, Security, or Breach Notification Rules, you may file a complaint with the Office for Civil Rights (OCR). OCR can investigate complaints against covered entities (health plans, health care clearinghouses, or health care providers that conduct certain transactions electronically) and their business associations.

Click here to to file a complaint with OCR.

Health Plan Complaints

You have a right to know how your health plan handles complaints. Contact your health plan’s member services department to find out how to file a complaint about your health coverage.

If your issue is not resolved through your health plan’s complaint process, you can file a complaint through the agency in your state that oversees health plans.

Timely Complaint Resolution

State and federal laws require health plans to follow certain timelines when processing and responding to health care complaints. Check your health plan coverage information and/or contact your state regulatory agency to learn about these timelines. The role of the state regulatory agency is to, among other things, educate consumers about their health care rights, resolve consumer complaints against health plans, help consumers understand their coverage benefits, and assist consumers in getting timely access to appropriate health care services. Regulatory agencies thus protect consumers’ health care rights, ensure a stable healthcare delivery system, inform the government about changes in the way the health care industry operates; ensure higher safety standards; and attempt to improve health care quality and follow local, state, and federal guidelines.

Select your state using this tool to find out which state regulatory agency oversees health care insurance companies in your state.