PATIENTS’ RIGHTS AND RESPONSIBILITIES

The Member has the right to:

  • Exercise these rights without regard to age, gender, marital status, sexual orientation, race, color, religion, ancestry, national origin, and disability, and health status, source of payment or utilization of services.
  • Be treated with respect and recognition of their dignity and need for privacy.
  • Receive confidential treatment of all information and records associated with the member's care.
  • Be provided with information about the SELECT HEALTHCARE IPA, its services and the health care service delivery process, including how to obtain primary and specialty care, care and coverage when out of the service area and when to directly access emergency care or use 911 services.
  • Be informed of the name, qualifications and titles of the physician who has primary responsibility for coordinating the member's care, and be informed of the names, qualifications and specialties of other professionals who are involved in the member's care.
  • Have 24-hour access to the member's primary care physician (or covering physician).
  • Receive complete information about the diagnosis, proposed course of treatment or procedure, alternate courses of treatment or non-treatment, the clinical risks involved in each, and prospects for recovery in terms that are understandable to the member, in order to give informed consent or to refuse that course of treatment.
  • Have the right to have input into proposed treatment plans to include:




      



  • Be informed of continuing health care requirements following office visits, treatments, procedures and hospitalizations and how the organization evaluates new technology for inclusions as a covered benefit.
  • Actively participate in decisions regarding the member's health care and treatment plan.  To the extent permitted by law, this includes the right to refuse any procedure or treatment.  If the recommended procedure or treatment is refused, an explanation will be given addressing the effect that this will have on the member's health.
  • Have access to personal medical records.
  • Be informed of non-emergent cost of care and receive an explanation of the member's financial obligations prior to incurring the expense (including co-payment, deductibles and co-insurance).
  • Examine and receive an explanation of bills generated for services delivered to the member.
  • Be informed of applicable rules in the various health care settings regarding member conduct.
  • Express opinions or concerns regarding the care provided, and offer recommendations for change in the health care delivery process by contacting the SELECT HEALTHCARE IPA or Health Plan. The Health Plan will have a timely and organized system for resolving member complaints and formal grievances.
  • Be informed of their right to voice a complaint (grievance process) and challenge the decision regarding a denial (appeal process).
  • Change primary care physicians by contacting the Health Plan Member Services Department.
  • Receive reasonable continuity of care and be given timely and sensible responses to questions and requests made for service.
  • Formulate advanced directives for health care.
  • Have all member rights apply to the person who has legal responsibility to make health care decisions for the member.
  • Will provide its members, upon request, information about the SELECT HEALTHCARE IPA’s prior authorization protocols, the denial process, including criteria for determination, financial compensation requests, any practitioner incentive plans and the QM Program. Program.
  • Be informed that Utilization Management decision-making is based only on the appropriateness of care and service and existence of coverage for our patients; that the SELECT HEALTHCARE IPA does not specifically reward practitioners or other individual for issuing denials of coverage or care for patients; and financial incentives for Utilization Management decision-makers do not encourage decisions that result in underutilization of services.

-Members’ education regarding health needs, share findings of history and physical exams at SELECT HEALTHCARE SELECT HEALTHCARE IPA,
-Discussion of potential treatment options, side effects of treatment, management of symptoms and recognizes that the member has final determinations in the course of actions.