

1601
N. Tucson Blvd. Suite 9
Tucson, AZ 85716-3450
Phone: (800) 635-1196
Hotline: (800) 419-4777
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Association
of American Physicians and Surgeons, Inc.
A Voice for Private Physicians Since 1943
Omnia pro aegroto |
PATIENTS' BILL OF RIGHTS
adopted in 1995
All patients should be guaranteed the following freedoms:
- To seek consultation with the physician(s) of their choice;
- To contract with their physician(s) on mutually agreeable terms;
- To be treated confidentially, with access to their records limited to those involved in their
care or designated by the patient;
- To use their own resources to purchase the care of their choice;
- To refuse medical treatment even if it is recommended by their physician(s);
- To be informed about their medical condition, the risks and benefits of treatment and
appropriate alternatives;
- To refuse third-party interference in their medical care, and to be confident that their
actions in seeking or declining medical care will not result in third-party-imposed penalties
for patients or physicians;
- To receive full disclosure of their insurance plan in plain language, including:
- CONTRACTS: A copy of the contract between the physician and health care plan, and between the
patient or employer and the plan;
- INCENTIVES: Whether participating physicians are offered financial incentives to reduce treatment
or ration care;
- COST: The full cost of the plan, including copayments, coinsurance, and deductibles;
- COVERAGE: Benefits covered and excluded, including availability and location of 24-hour emergency
care;
- QUALIFICATIONS: A roster and qualifications of participating physicians;
- APPROVAL PROCEDURES: Authorization procedures for services, whether doctors need approval
of a committee or any other individual, and who decides what is medically necessary;
- REFERRALS: Procedures for consulting a specialist, and who must authorize the referral;
- APPEALS: Grievance procedures for claim or treatment denials;
- GAG RULE: Whether physicians are subject to a gag rule, preventing criticism of the plan.
Name Date
Address City State ZIP
**** Return to: Association of American Physicians and Surgeons, Inc. ****
1601 N. Tucson Blvd, Ste. 9, Tucson AZ 85716
(800) 635-1196 Fax (703) 716-3400
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