Your Rights as a Hospital Patient in New York State - Section 1

About Your Rights

As a patient in a New York State hospital, you have certain rights and protections guaranteed by state and federal laws and regulations. These laws and regulations help ensure the quality and safety of your hospital care. To help you understand your rights, the New York State Department of Health developed this booklet.

Keep this booklet for reference. Review it carefully and share the information with family and friends involved in your care.

You have the right to participate in decisions about your health care and to understand what you are being told about your care and treatment. For example, you are entitled to a clear explanation of tests, treatments and drugs prescribed for you. Don't hesitate to ask questions of your doctor, nurse or hospital staff members. You have a right to know what's going on.

Every patient is unique, every hospital stay is different. It is important to know what specific rights apply to you and what to do if you feel you need help. Some rights and protections, such as those that govern when you leave the hospital, depend on receiving correct written notices. You will also be provided with information explaining when and where to call or write for help.

If you have a problem or if you don't understand something, speak to your nurse, doctor, social worker or patient representative.

They can:

  • help you get answers;
  • arrange special help;
  • make contacts with your family;
  • get foreign language and sign language interpreters; and
  • generally make your hospital stay easier.

About Your Special Needs

Each hospital must make staff available to explain or answer questions about your rights and to provide information on how you can protect those rights.

  • If you are hearing or vision impaired, or if English is not your first language, skilled interpreters must be provided to assist you. Translations and/or transcriptions of important hospital forms, instructions and information must be provided to you if you feel you need them.

But you must speak up and ask questions.

You can contact a patient representative before you enter the hospital to be sure your special arrangements are made when you get there.

  • If you have a question about any of the information in this booklet or feel that your needs have not been adequately met, ask the patient representative or other hospital staff person for further explanation or contact the New York State Department of Health.

Concerns/Problems/Complaints About Your Hospital Care

If you have a concern, problem or complaint related to any aspect of care during your hospital stay, speak to your doctor, nurse or hospital staff member. If hospital staff has not resolved the problem, you may contact the New York State Department of Health by mail or phone.

You may call the toll-free number 1-800-804-5447 or you may file a complaint in writing and send it to:

New York State Department of Health
Centralized Hospital Intake Program
Mailstop: CA/DCS
Empire State Plaza
Albany, NY 12237

Questions or Comments: hospinfo@health.state.ny.us

If You Think You Are Being Asked to Leave the Hospital Too Soon. . .

You have the right to appeal decisions made by your doctor, hospital staff or your managed care plan:

  • about when you are to leave the hospital;
  • if you feel you are being asked to leave the hospital too soon;
  • if you believe you have not been given adequate or appropriate plans for your medical care and other services you may need after you leave the hospital;
    or
  • if needed services are not in place.

The law requires that you receive advance notice in writing telling you:

  • the date the physician and/or hospital plans to discharge you;
  • how to appeal if you wish to remain in the hospital; and
  • a special number to call with any problems related to leaving the hospital.

For Assistance/Help

There is an Independent Professional Review Agent (IPRA) for your area and your insurance coverage. Should you need assistance/help from the IPRA, the hospital will provide you with a phone number/ person to contact. See the Glossary for more information.

For Medicare Patients Only

If you feel that you are being asked to leave the hospital too soon and have not received advance notice telling you when to leave the hospital, ask for your discharge notice (called "The Important Message from Medicare about Your Rights"). If you are in a Healthcare Maintenance Organization (HMO), you should also request "The Important Message from Medicare about Your Rights". You must have this written discharge notice in order to appeal the physician's and hospital's decision about when you are to leave. See an "Important Message from Medicare about Your Rights" for a complete explanation.

For Managed Care Patients

If you are a patient enrolled in an HMO or managed care plan, first request/submit an expedited appeal to the HMO or plan's utilization review committee if you feel your benefits are unfairly limited or denied, or you are being asked to leave the hospital too soon, or that medically necessary services are inappropriately excluded from your coverage. If you are not satisfied with the outcome of that appeal request, you may contact the New York State Department of Health by calling: 1-800-206-8125.

The Managed Care Law of 1996 amending Public Health Law 4408, Disclosure of Information

You Have the Right to File A Complaint About:

Doctors or Physician Assistants

If you feel that you have received incompetent, negligent or fraudulent care from a doctor or physician assistant, you may file a report with the New York State Department of Health Office of Professional Medical Conduct (OPMC). OPMC investigates all reports of possible professional misconduct by physicians and physician assistants. Reports must include the full name and address of the doctor or physician assistant and all relevant information. Reports must be made in writing to:

New York State Department of Health
Office of Professional Medical Conduct
Intake Unit
Riverview Center
150 Broadway
Albany, NY 12204-2719

For more information or to obtain a complaint form, call 1-800-663-6114 or visit the Department of Health website at www.health.ny.gov.

Reports are kept confidential. An investigation may result in a formal hearing before a committee of the Board for Professional Medical Conduct. The Board consists of physicians and consumer members appointed by the Commissioner of Health.

See the Glossary for examples of "medical misconduct" by a doctor or physician assistant.

Other Health Care Professionals

If you feel you received incompetent, negligent or fraudulent care from any other licensed health care professionals, such as nurses, dentists, social workers, optometrists, psychologists, physical or occupational therapists and podiatrists, you may file a complaint by contacting:

New York State Education Department
Office of Professional Discipline
475 Park Avenue South
2nd Floor
New York, New York 10016
1-800-442-8106

Questions or Complaints About Your Hospital Bill or Health Insurance

  • As a hospital patient, you are entitled to an itemized bill.
  • Your hospital bill may identify a charge called a "surcharge." These surcharges fund important public programs and have existed in previous years, although they may not have appeared as separate costs on the bill. The surcharge represents an additional amount due on total hospital bills in New York State and, depending on your insurance contract, New York State law allows a portion of these costs to be billed to you.
  • Hospitals negotiate payment rates with insurers, HMOs and other types of managed care plans, as well as commercial insurers and self-insured groups. These rates may vary. Contact your insurer with any questions you may have regarding your coverage.
  • If you have questions about your coverage, the services billed or amounts paid, contact the hospital's billing office and your insurer to resolve any questions/ problems that you may have..

For Medicare Patients

If you are a Medicare patient and have questions about your hospital bill, call Medicare:

1-800-633-4227

For Managed Care Patients

If you are enrolled in a managed care plan and you are having trouble getting care or feel your care is not satisfactory, you may complain to the plan. The plan's handbook MUST tell you how to complain and how to get an immediate review. If you are not satisfied with the HMO or plan's response to your complaint, contact the New York State Department of Health at:

1-800-206-8125

Medicare managed care enrollees may call IPRO:

1-800-331-7767

Access to Your Medical Records

New York State law requires all health care practitioners and facilities to grant patients access to their own medical records. Section 18 of the Public Health Law contains procedures for making these records available and the conditions under which a provider can deny access. Patients may request information, in writing, as may parents or guardians who have authorized their child's care.

If you want to see your medical records, ask your doctor and/or the director of medical records at the hospital. New York State law guarantees you the opportunity to inspect your medical records within 10 days of your written request.

If you want to have a copy of your medical records, you must submit a written request to the hospital. Address the request to the Director of Medical Records at the hospital. If you request a copy of your records, the hospital may charge you up to 75 cents per page.

If the hospital fails to acknowledge or act on your request, you may complain to the Department of Health by calling 1-800-804-5447.

If you have been denied access to all or part of your hospital records, you may appeal to the New York State Department of Health Medical Records Access Review Committee. The hospital/doctor is required to provide a form (DOH-1989) that gives the reason(s) for denial and information on this appeals process.

Glossary
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