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Member Rights

 

PURPOSE:

To promote effective health care, ConnectCare is committed to maintaining a mutually respectful relationship with enrollees. A statement of enrollees’ rights recognizes the specific needs of enrollees, including the right to privacy and the right to be treated with dignity when receiving health care.

PROCEDURE:

ConnectCare is committed to treating enrollees in manner that respects their rights and recognizes their responsibilities. This information is made available on the ConnectCare Web site at www.connectcare.comwith a hard copy available upon request.

An enrollee has a right to:

  • Be treated with respect and without discrimination

  • ignity and privacy

  • Confidentiality and privacy regarding medical records and health information

  • Prompt access to quality healthcare services

  • Have a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage

  • Participate in decisions regarding his/her healthcare

  • Refuse treatment and to be informed of the consequences of doing so

  • Review test or exam results and to have them explained in an understandable language

  • Obtain copies of medical records upon request and payment of a fee

  • Express complaints and/or make appeals regarding medical care or ConnectCare

  • Receive information about ConnectCare, its services, practitioners and providers, and enrollee rights and responsibilities

  • Make recommendations regarding ConnectCare’s enrollee rights and responsibilities policies

An enrollee has a responsibility to:

  • Supply information needed by ConnectCare, practitioners and providers in order to provide care

  • Be on time for appointments and to provide notice of appointment cancellations

  • Pay applicable co-payments at time of service

  • Follow prescribed treatment, advice, and instructions agreed upon with providers and/or practitioners, asking for clarification when needed

  • Provide accurate and complete information regarding medical history and current problems

  • Be familiar with his/her health care plan and to adhere to its requirements

  • Notify the plan of changes in address, phone number, job status, family size or other factors affecting eligibility

  • Be an informed consumer of healthcare and to assume responsibility for his/her health

  • Understand his/her health problems and participate in developing mutually agreed upon treatment goals to the degree possible

  • Assume responsibility for his/her actions if the member refuses treatment and does not follow the provider’s instructions

Certified by NCQA since 2007

NCQA Certified Utilization Management"Achieving Utilization Management Certification from NCQA demonstrates that ConnectCare has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards." -- Margaret E. O'Kane, President, NCQA

NCQA has reviewed and certified ConnectCare's Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.