Rights & Responsibilities
We Honor Our Patients’ Rights
All of our patients are entitled to be treated in a manner that respects their rights. We
recognize the specific needs of our patients and maintain a mutually respectful relationship
with them. This is our commitment to the rights of our patients . . . and to those other than
the patient who are legally responsible for making health care decisions for the patient.
As our patient, you have the right to:
- Receive health care services regardless of your race, ethnicity, national origin, religion, sex, age, mental or physical disability or medical conditions, sexual orientation, claims experience, medical history, evidence of insurability (including conditions arising out of acts of domestic violence), genetic information, or source of payment.
- Receive information about us and our services, doctors, health care professionals and providers, and patients’ rights and responsibilities, as well as information about your health plan’s coverage for services you may need or are considering.
- Be treated with respect and recognition of your dignity and right to privacy.
- Be represented by parents, guardians, family members or other conservators if you are unable to fully participate in treatment decisions.
- Have information about our contracting physician and provider payments
agreements, as well as explanations for any bills you receive for services not
covered by us or your health plan.
- Receive health care services without requiring you to sign an authorization, release, consent or waiver that would permit us to disclose your medical information. We will treat information about you, including information about services and treatment we provide, as confidential according to all current privacy and confidentiality laws.
- Have round-the-clock access, seven days a week, to your PCP or an on-call physician when your PCP is unavailable.
- Know the name and qualifications of the doctor who is mainly responsible for coordinating your care . . . and the names, qualifications, and specialties of other doctors, and other providers who are involved in your care.
- Have a candid discussion of medically appropriate or necessary treatment options for your condition — regardless of the cost, the extent of your benefits or the lack of coverage. To the extent permitted by law, this includes the right to refuse any procedure or treatment.
- Actively participate in decisions regarding your health care and treatment plan and receive services at your own expense if we deny coverage. You and your treating doctor or health care provider decide whether you will receive a particular service or treatment
- Receive complete information — before receiving care and in terms you can understand — about an illness, proposed course of treatment or procedure, and prospects for recovery, so that you may be well informed when consenting to refuse a course of treatment. This includes:
- being able to request and receive information about how medical treatment decisions are made by our review staff, and
- the criteria or guidelines applied when making such decisions, and
- an explanation of the cost of the care you will receive and what you will be expected to pay out of your own pocket
- Except in emergencies, this information will include a description of the recommended procedure or treatment, the medically significant risks involved, any alternate course of treatment or non-treatment and the risks involved in each and the name of the person who will carry out the recommended procedure or treatment.
- Receive information about your medications - what they are, how to take them, and possible side effects
- Reasonable continuity of care and to know the time and location of appointments, the name of the physician providing care and continuing health care requirements following discharge from inpatient or outpatient facilities.
- Be advised if a doctor proposes to engage in experimental or investigational procedures affecting your health care or treatment. Patients have the right to refuse to participate in such research projects.
- Obtain upon request a copy or summary of the Utilization Management Program Description and the Quality Improvement Program Description that we publish annually.
- Voice complaints about us or appeal our care decisions.
- Be informed of rules about patient conduct in any of the various settings where you receive health care services as our patient.
- Complete an advance directive, living will or other instructions concerning your care in the event that in the future you become unable to make those decisions while receiving care through our physicians, healthcare professionals and providers.
- Make recommendations about these patients’ rights and responsibilities policies.
- Be notified following a breach of your unsecured protected health information
- To opt out of receiving fundraising communications.
- A description of the types of uses and disclosures of protected health information that require an authorization, including the use and disclosure of PHI for marketing purposes and disclosures that constitute a sale of PHI.
- A statement that other uses and disclosures not described in the notice will be made only with written permission.
Our Patients Share Responsibility for Their Care
Just as we honor our patients’ rights, we have expectations of our patients. You have a responsibility to:
- Be familiar with the benefits, limitations and exclusions of your health plan coverage.
- Supply your health care provider with complete and accurate information which is necessary for your care (to the extent possible).
- Be familiar and comply with our rules for receiving routine, urgent, and emergency care.
- • Contact your PCP (or covering doctor) for any non-urgent or emergency care that you may need after the doctor’s normal office hours, including on weekends and holidays.
- Be on time for all appointments and notify the physician’s or other provider’s office as far in advance as possible for appointment cancellation or rescheduling.
- Obtain an authorized referral form from your PCP before making an appointment with a specialist and/or receiving any specialty care.
- Understand your health problems . . . participate in developing mutually agreed upon treatment goals to the degree possible . . . and inform your doctors and health care providers if you do not understand the information they give you.
- Follow treatment plans and instructions for care you have agreed on with your doctors and health care providers, and report changes in your condition.
- Accept your share of financial responsibility for services received while under the care of a physician or while a patient at a facility.
- Treat your doctors and health care providers and their office staff with respect.
- Contact our Member Services Department or your health plan’s member services if you have questions or need assistance.
- Respect the rights, property and environment of your physicians and health care providers, their staff and other patients