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Know your healthcare rights, responsibilities

Mike Pavlakis

The basics of healthcare begin with an honest assessment of your genetics and environment. A visit to your family doctor (annual check-ups are recommended), will help you identify risks and establish a base line for future comparison and treatment options. Additionally, simple lab tests will help your doctor identify abnormalities.

Most of us realize that a good diet and regular exercise will help us stay healthy. Reading labels and avoiding highly processed foods and foods with too many of the bad fats, sugars, salts, and chemicals will help fight against illnesses such as heart disease, diabetes, and stroke. Further, moderating the use of alcohol and avoiding cigarettes and tobacco can assist in life-long health benefits.

Our local area is blessed with a number of primary care givers including physicians, dentists, nurses, therapists, and a recognized regional medical center, that provide everything from emergency care to open heart surgery. To maintain good health, it is important to establish ourselves and family members with a primary care giver. If you don’t have a family doctor, get one. Many of our local physicians are accepting new patients, and it is important to get established with a provider with whom you feel comfortable.

Your primary care provider can refer you to specialists for diagnosis and treatment of specific conditions or disease. Locally, we have a number of cardiologists, neurologists, urologists, oncologists, nephrologists, dermatologists and surgeons who provide excellent service.

Effective healthcare goes beyond a basic understanding of genetics, our environment and access to talented healthcare professionals. Effective healthcare requires an understanding of our rights and responsibilities including: The Affordable Care Act, Health Insurance Portability and Accountability Act, Family Educational Rights and Privacy Act, Powers of Attorney, and Health Care Directives.

The Affordable Care Act (ACA), more widely known as Obama Care, requires that each of us have, whether provided by our employer or purchased in the open market, health insurance which provides minimum levels of coverage, or pay a tax (subject to certain hardship exceptions). The ACA also provides for dependent insurance through age 26 and also prohibits certain exclusions from coverage for preexisting conditions. The ACA places emphasis on Patient Centered Outcomes and Quality of Care reporting including ratings and grades which are available on the Internet. This information is utilized by providers to align treatment with the patient’s wishes as well as providing consumers with valuable patient satisfaction reporting to assist in selecting treatment options. Beginning in 2015, the ACA required “large employers” (generally defined as employers who employ 50 or more employees full time) to offer “minimum essential coverage” to their employees and their dependents that is both “affordable” and provides “minimum value.” Although these same rules are not yet in effect for small employers, the ACA does offer tax credits to small employers who offer employee health coverage.

From the consumer’s perspective, in addition to the so-called individual mandate to purchase insurance, it is important to think about an advance Health Care Directive and a Health Care Power of Attorney before we get sick or hospitalized. When these events occur, we are not thinking clearly, and we need to have documents in place expressing our wishes regarding care and treatment. Additionally, we need to name the person who is authorized to speak for us in the event we are unable to speak for ourselves. These types of documents are provided for by statute, and are not difficult or expensive to have prepared. The federal law known as HIPAA (the Health Insurance Portability and Accountability Act) protects a patient’s right to privacy and prevents providers from sharing or discussing health care information with people who are not authorized to receive it.

And, don’t forget about your children’s health and records. Elementary schools and nurses are bound by FERPA (the Family Educational Rights and Privacy Act), which like HIPAA, limits access to student’s educational records, which includes their medical records. Access to these records in case of emergency can be critical, so it is important that parents and guardians make proper designations on school records of who can have access to their student’s medical records.

Attorneys often are asked, “What happens if I don’t make a designation” for a Health Care Power of Attorney? Almost universally, the answer is that there will be a delay in care while the providers attempt to determine who they can talk to about the care to be provided to the patient while they cannot speak for themselves. Delay can make a difference in outcome, so each of us, regardless of age, should make and execute Health Care Directives and Powers of Attorney. Even if you do not have someone who you are comfortable with making proper decisions for you, a Health Care Directive can still be created.

Healthcare Tips:

Be sure to review your health records periodically, to be clear that you understood what the provider diagnosed and recommended (and that the provider understood you as well).

Be sure to update your Health Care Directives, Power of Attorney, Living Wills etc. often. As we move through the various phases of the life cycle, our wishes and needs will change. It is important to stay abreast of these changes and modify legal paperwork accordingly.

For those who are disabled or unable to afford private insurance, Medicare and Medicaid benefits are available. These government programs have been around for a long time, and like private insurance, they can help patients navigate the health care system.

For veterans, there are a number of facilities available that provide excellent service to those who have served our country.

With so many treatments and drugs being developed, we are enjoying healthier, longer lives. However, our healthcare is our individual responsibility, and although there are resources available to us, it is up to us to take advantage of those resources. Be sure to understand your healthcare rights and consult with experienced and competent legal counsel to help you navigate the complicated healthcare landscape. Get your healthcare questions answered and your wishes documented so you and your loved ones can focus on you.

Mike Pavlakis, an attorney with Allison MacKenzie in Carson City, is a specialist in healthcare law.