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Member Rights

The Member has the right to:

1. Exercise these rights without regard to gender, sexual orientation or cultural, economic, educational, or religious background. 

2. The member has the right to request a copy of their medical records and that they be amended or corrected

3. Be provided with information about the IPA, its services, and the health care service delivery process.

4. Be informed of non-emergent cost of care and receive an explanation of the member’s financial obligations as appropriate, prior to incurring the expense (including co-payments, deductibles, and co-insurance).

5. Examine and receive an explanation of bills generated for services delivered to the member.

6. Be informed of the name and qualifications of the physician who has primary responsibility for coordinating the member’s care; and be informed of the names, qualifications, and specialties of other physicians and non-physicians who are involved in the member’s care.

7. Have 24-hour access to the member’s primary care physician (or covering physician).

8. 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. Member has right to candid discussion of appropriate or medically necessary treatment options for their condition, regardless of cost or benefit coverage.

9. Actively participate indecisions 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.

10. Be treated with respect and dignity.

11. Receive considerate and respectful care with full consideration of the member’s privacy.

12. Receive free language interpretation services upon request which includes the provision of member information in large print Braille or recorded format for the visually impaired.

13. Receive confidential treatment of all information and records associated with the member’s care.

14. Be informed of applicable rules in the various health care settings regarding member conduct.

15. Express opinions or concerns about the IPA or the care provided and offer recommendations for change in the health care service delivery process by contacting the IPA Member Services Department.

16. Be informed of the member grievance and appeal process.

17. Change primary care physicians by contacting the Member Services Department.

18. Receive reasonable continuity of care and be given timely and sensible responses to questions and requests made for service.

19. Be informed of continuing health care requirements following office visits, treatments, procedures, and hospitalizations.

20. Have all member rights apply to the person who has the legal responsibility to make health care decisions for the member.

21. Patients will be referred directly to health plan for issues related to linguistic access and cultural competency issues.

Member Responsibilities

The Member has the responsibility to:

1 Be familiar with the benefits and exclusions of the member’s health plan coverage.

2. Provide the member’s health care provider with complete and accurate information, which is necessary for the care of the member (to the extent possible).

3. Be on time for all appointments and notify the provider’s office as far in advance as possible for appointment cancellation or rescheduling.

4. Report changes in the member’s condition according to provider instructions.

5. Inform providers of the member’s inability to understand the information given to them.

6. Carry-out the treatment plan, which has been developed and agreed upon by the health care provider and the member.

7. Contact the member’s primary care physician(or covering physician) for any care, which is needed after that physician’s normal office hours.

8. Treat the health care providers and staff with respect.

9. Obtain an authorized referral from the member’s primary care physician for a visit to a specialist and/or to receive any specialty care.

10. Be familiar and comply with the IPA health care service delivery system regarding access to routine, urgent, and emergent care.

11. Contact the IPA Member Services Department or the member’s Health Plan Member Services Department regarding questions and assistance.

12. Respect the rights, property and environment of all physicians and IPA providers, staff, and other members.

13. Have all of these responsibilities apply to the person who has the legal responsibility to make health care decisions for the member.

14. Notify the organization and the treating practitioner if an individual disenrolls from a program.