Member rights
Dignity and respect
You have the right to be treated with consideration, dignity and respect. You also have the responsibility to respect the rights, property and environment of all physicians and other health care professionals, employees and other patients.
You have the right to access your own medical records and to have the privacy and the confidentiality of those records maintained.
You are also entitled to exercise these rights regardless of gender, sexual orientation, marital status or culture, economic, educational or religious background.
Knowledge and information
You have the right — and the responsibility — to know about and understand your health care and your coverage, including:
- How your health plan operates — as stated in your Member Handbook and Evidence of Coverage.
- Participating actively in decisions regarding your medical care. Having participated in and agreed to a treatment plan, you have a responsibility to follow the treatment plan or advise your physician otherwise.
- The names and titles of all physicians and other health care professionals involved in your medical treatment.
- Your medical condition and health status.
- Responsibility to understand your health problems and participate in developing mutually agreed upon treatment goals, to the degree possible.
- Any services and procedures involved in your recommended course of treatment.
- Receive information about our organization, its services, its practitioners and providers and members’ rights and responsibilities, including making recommendations regarding these member rights and responsibilities.
- A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage.
- Any continuing health care requirements following your discharge from the physician's office or from the hospital.
- The medications prescribed for you — what they are, what they are for, how to take them properly and possible side effects.
Member resources
As a partner with those involved with your care; your health plan, your physician, and other health care professionals who may be involved in your care, you have the right to:
- Contact Customer Service for questions/concerns regarding:
- Authorization status
- Medical Group information (Contracted physicians, hospitals, lab services, radiology, etc.)
- Complaints
- Receiving bills/statements
- General questions
- Contact your health plan member services department for questions/concerns regarding:
- Eligibility Information
- Benefits/copay information
- Formal grievances
- Appeal for denial of claims/requested services
- Receiving bills/statements
- General questions
- Your Primary Care Physician (PCP) should be contacted with any questions regarding any medical advice or prescribed treatment if you need an explanation or want more information.
Member responsibility
As a partner in your own health care, you have the right to:
- Refuse treatment — providing you accept responsibility and the consequences of such a decision.
- Complete an Advance Directive.
- Refuse to participate in any medical research projects.
- You also have the responsibility to:
- Identify yourself by presenting your current health plan ID card (to physician, laboratory, hospital, etc.) when receiving medical services.
- Provide your current primary care physician with all previous medical records as well as providing accurate and complete medical information to all physicians and other health care professionals involved in the course of your treatment.
- Be on time for all appointments and to notify your physician's office as far in advance as possible if you need to cancel or reschedule an appointment.
- Receive all non-emergent or urgent care through your assigned PCP.
- Obtain a referral from your PCP for specialty care and cooperate with all persons providing you with medical care.
- Notify your health plan as well as PCP within 48 hours — or as soon as possible — if you are hospitalized or receive emergency or out-of-area urgent care.
- Pay all required copayments at the time you receive health care services.
- Identify yourself by presenting your current health plan ID card (to physician, laboratory, hospital, etc.) when receiving medical services.
You have the right at any and all times to contact Customer Service for assistance with issues regarding your health plan.
It is your right to have all the above rights apply to the person you have designated with legal authority to make decisions regarding your health care.