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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