Rights & Responsibilities

As a member of Care Choices HMO, you are a member of the team that keeps you well. Care Choices HMO and your primary care physician
work hard to keep you and your family healthy. You also play an important team role.

To get the most from Care Choices HMO, you must understand your rights and responsibilities. Your rights are what you can expect from Care
Choices HMO. Your responsibilities are what Care Choices HMO expects from you.

Your rights are what you can expect from Care Choices HMO.

As a Care Choices HMO member, you have the right to:

• Receive information about Care Choices HMO, our services, our participating practitioners, facilities, providers and your rights and responsibilities.
• Understand the services we provide.
• Make recommendations regarding the Care Choices HMO Member Rights and Responsibility policy.
• Receive courteous, timely, accessible, and quality health care.
• Be treated with dignity, respect and privacy.
• Expect that your records will remain private and confidential.
• Get information about how we pay our providers.
• Know and understand your diagnosis and treatment options.
• Be involved with your provider in making decisions about your treatment.
• Have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
• Voice your complaints and appeals about Care Choices HMO complaint decisions or the care its providers deliver by following our Grievance Appeal Process.
• Expect that Care Choices HMO will fully investigate the substance of a complaint or grievance in a timely manner.
• Be eligible for election to the Care Choices HMO Board of Directors.

Your responsibilities are what Care Choices HMO expects from you.

As a Care Choices HMO member, you have the responsibility to:

• Inform your physicians, practitioners and Care Choices HMO (to the extent possible) of any information needed to provide you with care.
• Select a Care Choices HMO participating primary care physician.
• Use Care Choices HMO participating physicians and health care facilities.
• Call your primary care physician when you need care.
• Call Care Choices HMO to change your primary care physician.
• Understand your health needs and participate mutually with your provider to develop your treatment goals (to the degree possible).
• Follow your provider's instructions for the care you have agreed on with your provider.
• Be on time for appointments and call the physician right away if you must cancel.
• Carry your Care Choices HMO member ID card and present it when you receive care.
• Call your primary care physician within 48 hours of receiving emergency care so that he or she can arrange your follow-up care.
• Tell your physician and Care Choices HMO if you are covered by other health care coverage.
• Pay any copayments, coinsurance and/or deduc-tibles, when applicable, when you receive care.
• Tell us if you move, change your address, or add or drop a family member under your benefits.
• Follow all Care Choices HMO procedures.
• Pay for services that are not covered by Care Choices HMO if you seek or receive these services.
• Request that Care Choices HMO review and approve all services that must be certified or approved in advance.
• Pay for covered services when you choose to obtain services and do not follow Care Choices HMO rules that require that you request and receive approval in advance.
• Call Customer Service if you have any questions.
• Keep your health care benefits and coverage changes current.