Legal Ethics Patients Rights and HIV AIDS

Legal Ethics, Patients’ Rights, and HIV/AIDS

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Legal Ethics, Patients’ Rights, and HIV/AIDS

Patient’s claim denial:

There are various claims of the patients denied due to various reasons. Especially, after the Obamacare it gives more protection to the people as patients enrolled with the Obamacare will not be denied with the insurance claim (Bartolone, 2014). There are various process and procedures adopted by the insurance company to validate the claim.

Following are the some of the common reason for rejecting the insurance claims:

It is essential in identifying the reasons for rejecting a claim of patient. From the above-mentioned points, it is clear that the main reason for such rejection. In order to address these problems, it is essential to have more organized and devised structure so that patients get benefit out of their insurance.

  1. Invalid POS.
  2. Invalid age group.
  3. Duplicate claim.
  4. Invalid units.
  5. Patient does not possess valid Target Pop
  6. Daily limit has exceeded.
  7. Authed units exceeded (, 2014).
  8. Service not in provided claim.
  9. Service is not authorized.
  10. Incomplete or inaccurate insurance information.
  11. Error in coding and omissions of diagnosis and procedures.
  12. Insufficient medical necessity (Brozak, 2013).

Hospital must provide their best support to their patients in claiming their insurance. A hospital must essential possess a management team who will be in a position to coordinate between the patient and insurance company (Brozak, 2013). It will enable the hospital in providing all the required information to the insurance company. By providing all the required information in an appropriate manner, will reduce the chances of a claim getting rejected.

In order to obtain more benefit from the insurance, it is essential to have more effective doctors and other medical professionals. One cannot ignore the point of unnecessary medication. If doctors are well qualified, experienced, and knowledgeable such situations can be avoided. Similarly, all technicians must be knowledgeable and qualified so that they provide more authentic report about the actual medical condition of the patient. It will enable in proper diagnosis and in avoiding unnecessary medical expenses (Brozak, 2013).

From the insurance company, it is essential to recruit more knowledgeable person to have interaction with the clients. The representative must know and explain all the details about a particular insurance plan to the people even without their interference. It will enable the people in understanding about the actual benefit of the insurance plan. It will enable them in understanding about what are the claims they are eligible for and not (, n.d.). By making a detailed explanation patient will avoid unnecessary problem or rejection in the future.

Similarly, it is the responsibility of the insurance company to have a coordinator who will be in a position to coordinate with patients incase of hospitalization or any insurance claim. The coordinator must be intimated about the medical treatment that is being undertaken by the insured prior to filing a claim. Coordinator along with hospital and other medical professionals will prepare insurance claim for the insured. It will reduce the amount of claim rejection.

The insurance company will be legally challenged if they reject a genuine claim. Insurance company must recruit suitable candidates who will process all the required claims of the people so that promised benefits are delivered (, n.d.). Accountability of employee and all other professionals must increase so that insured will get promised benefit.

Hospital staffing:

Hospitals have staffs at different levels that are responsible for various roles and responsibilities. Code of ethical behaviour is essential to ensure that patients’ problems are solved, and they are happy with the hospital’s service (, n.d.). Patients have the rights in safeguarding their personal dignity which can be achieved only through proper human resource management system of the hospital (, n.d.).

Mostly nurses are dealing with the in-patient, and they are responsible in treating the patient with dignity. Nurses spend more time with the patients and they provide immediate attention and care to the patients. It is essential to have a more drafted recruitment plan for the nurse. Recruitment of nurses must be stringent, and they must be aware of the requirement of the hospital (Mensik, 2014). Staffing appropriate nurses to provide the required service to the patients are remaining as a great challenge.

Similarly, management staffs must be kind in providing appropriate guidance and must treat the patient and their family with due respect. They must be in a position to provide clear guidance about the payment system, appointment and with other required information. At the time recruitment, it is essential for the hospital to provide clear do’s and don’ts to the candidates. Recruitment procedure must include the evaluation about the behaviour and personality of the candidates in order to understand the attitude towards the patients.

Rigorous and continuous training must be providing to all level of staffs in order to ensure that employees are upholding the ethical values and principles of the hospital (, n.d.). Always high quality of health care services must be emphasised by the hospital and staffs are accountable for their job (, n.d.). Employees must be aware of various rules, regulations and laws so that they will be in a position to avoid committing mistakes in discharging their duties.

Staffing at all level must ensure that candidates are honest and will follow all the rules and regulations of the hospital. Hospital management must be strong and must be in a position to monitor and correct the deviation at the initial stage in order to avoid adversities in the future (, n.d.). Employee motivation is required that is employees work must be recognized in order to motivate them to continuing to discharge their duty as per the ethical standards.

There must be more cooperation and coordination among the employees in order to achieve such success. There must be proper guidance and training provided at various stages in order to maintain ethical behaviour of the employees (Deshpande, n.d., p. 3). At all level ethical behaviour is given due importance especially to nurse and management staff. Nurses create great impact and impression about the hospital and the services provided as they are closely associated with the patients.

There must be rigorous training and monitoring system required besides stringent staffing procedure to ensure that patients are satisfied, and they are treated well with dignity (Deshpande, n.d., p. 3). Nurses require more recognition and motivation to discharge their duty as per the ethical standards. Positive attitude and motivation will enable them to treat a patient with care (Deshpande, n.d., p. 4).

Besides this, there must be ethical climate that is the management of the hospital must be ethical and must emphasis on ethical behaviour. If the management of the hospital is disclosing ethical behaviour then, all employees will follow the ethical behaviour.

Focus on HIV/AIDS patients:

Health care laws are proposed to protect the information of the patient and to provide due care and service to the patients. Incase of HIV/AIDS patients it is essential for the hospital to behave appropriately in order to avoid legal adversities. Primarily it is essential to maintain the confidentiality of the patient information (, n.d.). It is a punishable offense if this patients information are shared with others without any medical benefit.

Punishment differs with the amount of crime committed by the medical professional. It is categorized as criminal charges if the medical professional is not treating a patient only for the reason of HIV/AIDS. In other words, refusing to provide any medical assistance and services to the patients with HIV/AIDS is a criminal charge (Pope & Morin, n.d.). Similarly, it is the responsibility of the health care to provide immediate update about the HIV/AIDS patient to the public health authorities as it the major responsibility of the medical system (Wolf & Lo, 2001). It cannot be considered as a breach of legal responsibility of confidentiality as this information is necessary for the public welfare and future research. But at the same time, it differs from state to state; therefore it is essential for the health care to pay more attention to the state law in order to avoid legal charges (Wolf & Lo, 2001).

HIV/AIDS patients must be given more psychological support and must be treated with dignity. Failing that will result in legal ramification. Patients affected with HIV/AIDS mostly are socially demoralized, and they must be treated in an ethical manner to avoid further distortion. Hospitals must provide proper drugs and guidance to these patients in order to avoid more trouble.

Similarly, medical professionals providing least preference to these patients are subject to legal charges. Ignoring these patients compliance and not providing appropriate treatment to these patients’ results in more legal issues to the health care. Health care will be penalized for breaching the data and violation of privacy as per HHS. Antitrust issues are the next major issue which results in legal charges as per Federal antitrust law (Page & Fields, 2011). Health care cannot charge different prices for services rendered to HIV/AIDS patient.

Patient care is the crucial factor which has a direct impact over the health care services provided. It is essential for the health care to maintain and provide quality service in order to obtain patient satisfaction (Thomas, Rogers, & Maclean, n.d.). It is essential to increase the overall coordination with the patient in order to provide better services to them. Health care must dedicate service to the HIV/AIDS patient. These patients must be provided with separate attention and care so that these patients will not face any adversities (, 2014). Health care must facilitate in providing service to various stages of HIV/AIDS patient. Similarly, health care must provide a separate counsellor for dealing with these patients and who will provide more motivation to the patients (, 2014). There must be separate electronic system to make an update about the records of these patients.

Few nurses must be recruited and provided with more training in handling these patients. It will enable in establishing proper contact with the patient and in providing ethical services to them. It is the responsibility of health care in making detailed examination before discussing with the patients so that they will not get hurt. These patients if not treated with due respect and dignity may take more adverse step like suicide (Pope & Morin, n.d.). Health care must have a dedicated management who will establish contact with the patients on a timely basis. It ensures that they are treated with dignity, and these patients are cared by the hospital.

Besides medication, psychological factors play a significant role in managing these patients. These patients compliance will be considered serious and immediate action will be taken against the staff to ensure that other staffs are not committing such mistakes. Thus, HIV/AIDS patients are given due preference and more trained staffs will take care of them.

References (2014, November 21). The Affordable Care Act and HIV/AIDS. Retrieved from (n.d.). HIV & AIDS Information :: HIV and the law – Confidentiality. Retrieved from

Bartolone, P. (2014, April 14). Patients Often Win If They Appeal A Denied Health Claim | Kaiser Health News. Retrieved from

Brozak, S. (2013, October 26). The 5 Things You Should Know When Your Healthcare Claim Is “Denied” – Forbes. Retrieved from (2014). AlphaMCS Claim Validation Guide. Retrieved from

Deshpande, S. P. (n.d.). Factors Impacting Ethical Behavior of Hospital Employees: An Empirical Investigation. Retrieved from (n.d.). Code of Ethical Behavior. Retrieved from (2014, November). HIV Clinical Resource : UPDATE: Primary Care Approach to the HIV-Infected Patient. Retrieved from

Mensik, J. (2014, February). What every nurse should know about staffing – American Nurse Today. Retrieved from

Page, L., & Fields, R. (2011, March 14). 13 Legal Issues for Hospitals and Health Systems. Retrieved from (n.d.). What to Do with a Denied Claim | Patient Navigator. Retrieved from

Pope, K. S., & Morin, S. F. (n.d.). AIDS and HIV: Research, Ethical Responsibilities, Legal Frameworks, Resources. Retrieved from (n.d.). Code of Ethical Behavior – South Shore Hospital, South Weymouth – Boston, Massachusetts (MA). Retrieved from (n.d.). Code of Ethical Behavior – South Shore Hospital, South Weymouth – Boston, Massachusetts (MA). Retrieved from

Thomas, M., Rogers, R., & Maclean, R. (n.d.). Internet Scientific Publications. Retrieved from

Wolf, L. E., & Lo, B. (2001). Ethical Dimensions of HIV/AIDS. Retrieved from