The Obama administration tinkered on Wednesday with recent rules that provide patients more clout in disputes with health insurers, altering the standards in ways that disappointed leading advocates for healthcare consumers. The rules are intended to guarantee patients nationwide the same rights to appeal if their insurers do not cover care that they consider necessary. The federal standards, part of the 2010 law to overhaul the healthcare system, replace a patchwork of separate state policies. The rules allow patients to protest to their health plans and, if that does not work, to take their complaints to an outside arbiter. Health and Human Services officials issued the rules 11 months ago, but they have been working to fine-tune them amid a blizzard of lobbying. Insurers and employers have been urging limited rights to appeal, while consumer groups have been arguing for stronger patient protections.