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Patient Bill of Rights (Article 11)
What You Need to Know  

As a TRICARE beneficiary, it’s important to understand that you have both rights and responsibilities when it comes to your health and the health care services you receive within the Military Health System (MHS).

The health care Consumer Bill of Rights and Responsibilities (Patient Bill of Rights) was created in 1997 by the Clinton administration’s Presidential Advisory Commission on Consumer Protection and Quality in the Health Care Industry.

Many health plans, including all of the plans sponsored by the Federal government, have adopted these general principles. The following is a summary of TRICARE’s Patient Bill of Rights.


Your Rights
Patient rights fall into the following seven categories:


Getting Information
You have the right to receive accurate, easy-to-understand information through written materials, presentations and TRICARE representatives to help you make informed decisions about TRICARE programs, medical professionals and facilities.

Choosing Providers and Plans
You have the right to a choice of health care providers that is sufficient to ensure access to appropriate, high-quality health care.

Emergency Care
You have the right to access emergency health care services when and where the need arises. You are not required to obtain prior authorization for care if you have reason to believe your life is in danger or you would be seriously injured or disabled without immediate care.

Participating in Your Treatment
You have the right to receive and review information about diagnosis, treatment and the progress of your condition, and to fully participate in all decisions related to your health care. If you are unable to fully participate in treatment decisions, you have the right to be represented by family members, conservators or other duly appointed representatives.

Respect and Nondiscrimination

You have the right to considerate, respectful care from all members of the health care system at all times and under all circumstances.

If you are eligible for coverage under the terms and conditions of TRICARE or as required by law, you must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information or source of payment.

Confidentiality of Your Health Information
You have the right to communicate with health care providers in confidence and to have the confidentiality of your individually identifiable health care information protected. You also have the right to review and copy your own medical records and request amendments to your records.

Complaints and Appeals
You have the right to a fair and efficient process for resolving differences with your health plan, health care providers and the institutions that serve them. This includes a rigorous system of review.

Your Responsibilities
As a beneficiary in the MHS, you are expected and encouraged to assume reasonable responsibility for your health. Such responsibilities include:

Maximizing Your Health
You have the responsibility to maximize healthy habits, such as exercising, maintaining a healthy diet, and not smoking.

Making Smart Health Decisions
You have the responsibility to be involved in health care decisions. This means working with providers in developing and carrying out agreed-upon treatment plans, disclosing relevant information and clearly communicating your needs.

Becoming TRICARE Savvy

You have the responsibility to be knowledgeable about TRICARE coverage and program options, including covered benefits; limitations; exclusions; rules regarding use of network providers; coverage and referral rules; appropriate processes to secure additional information; and appeals, claims and grievance processes.

You also have the responsibility to:
 
  • Show respect for other patients and health care workers.
  • Make a good-faith effort to meet financial obligations.
  • Use the disputed claims process when there is a disagreement.
  • Report wrongdoing and fraud to appropriate resources or legal authorities.
  • Keep your Defense Enrollment Eligibility Reporting System (DEERS) information current.
Visit the TRICARE Web site to read the complete text of the “Patient Bill of Rights and Responsibilities in the Military Health System.”


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Last Reviewed:  December 4, 2007