Member Bill Of Rights

MEMBER RIGHTS & RESPONSIBILITIES

As a Member, You Have the Right to:

Quality of Care

1. A right to receive information about Physicians' Healthways IPA (PHW), its services, its practitioners and providers and members' rights and responsibilities.

2. A right to be treated with respect and recognition of dignity and right to privacy.

3. A right to participate with practitioners in making decisions about your health care.

4. A right to have a practitioner inform you of treatment (without regard to plan coverage), risks, benefits and consequences of treatment or non-treatment.

5. A right to a candid discussion of appropriate or medically necessary treatment options (side effects of treatment, and management of symptoms) for your condition, regardless of cost or benefit coverage.

6. A right to voice complaints or appeals about PHW or the care it provides.

7. A right to make recommendations regarding PHW members' rights and responsibilities policies.

8. A right to be represented by parents, guardians, family members or other conservators for those who are unable to fully participate in their treatment decisions.

9. A right to choose the final course of action among clinically acceptable choices.

10. A right to have the provider share findings of history and physical examinations and education regarding your health needs.

Language & Interpreter Services

1. Right to an Interpreter / interpreter service. *(Hearing Impaired) If you are 12 years old & above, you have the right to an interpreter, that is not a family member, with “sensitive services” pertaining to your health.

2. For Medi-Cal & Healthy Family members, the interpreter service is available 24 hours and is free of charge.

3. Exercise these rights regardless of your race, handicap, color, gender, sexual orientation, creed, age, religion or your national origin, cultural or educational background, or your economic or health status, or source of payment for your health care.

Confidentiality

1. You have the right to access personal health information.

2. You may access your medical records from your practitioner at any time, or grant permission for the records to be sent to another facility for any purpose. However, prior to the release of the records, you must first sign a "Release of Medical Records" form to grant authorization.

3. You may request restrictions on use or disclosure of your personal health information. For more information contact member services at (626) 388-2300.

4. Complete an Advance Directive, living will or other directive to your practitioner.

Access To Care

1. Choice of quality contracting physicians and Hospitals.

2. Timely access to your Primary Care Physician and referrals to specialists when Medically Necessary.

3. Use Emergency Services when you believe you have a serious, sudden injury or illness that could permanently impact your health.

4. Refuse treatment or leave a medical facility, even against the advice of physicians – providing you accept the responsibility and consequences of the decision.

5. Be informed of continuing health care requirement following discharge from inpatient or outpatient facilities.

6. Eligible Enrollees are informed of their rights to access Hospice Care.

7. Reasonable continuity of care and to know the time and location of an appointment as well as the physician providing care.

8. Member is allowed continued care when undergoing an active course of treatment with a physician that leaves PHW. For more information contact Member Services at (626) 388-2300.

Timely Problem Resolution

1. Voice complaints and appeals without discrimination and expect problems to be fairly
examined and appropriately addressed in an appropriate time frame.

2. The right to file a complaint or grievance if linguistic needs are not met.

Health Plan Information

1. Information about your health plan/IPA covered services and procedures.

2. Know the names and qualifications of physicians and health care professionals involved in
your medical treatment.

3. Be provided information regarding how medical treatment decisions is made by the
Participating IPA or health plan.

4. Be advised if a physician proposes to engage in experimentation affecting your health care or treatment.

5. Examine and receive an explanation of any bills for non-covered services, regardless of
payment source.

As a Member, You Have the Responsibility to:

1. Provide your physicians or other care Providers the information needed in order to care for you.

2. A responsibility to supply information (to the extent possible) that PHW and its practitioners and providers need in order to provide your care.

3. A responsibility to follow plans and instructions for care that has been agreed on with practitioners.

4. A responsibility to understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.

5. Do your part to improve your own health condition by following treatment plans, instructions and care that you have agreed on with your physician(s).

6. Adhere to behavior that reasonably supports your treatment plan and the recommendation of your Primary Care Physician or other contracting medical provider.

7. Behave in a manner that supports the care provided to other patients and the general functioning of the Facility.

8. Accept the financial responsibility (Copayments, coinsurance and deductibles) associated with services received while under the care of a physician or while a patient at a Facility.

9. Review information regarding covered services and procedures as stated in this brochure.

10. Ask questions of your contracting physicians or health plan.

If you have a suggestion, concern, or a payment issue, call the 800 number on your I.D. card. IF YOU WISH TO CHANGE TO A DIFFERENT PRIMARY CARE PHYSICIAN, PLEASE CALL YOUR HEALTH PLAN MEMBER SERVICES DEPARTMENT (Tel. Number printed on you ID Card), or call Physicians' Healthways IPA Member Services at (626) 388-2300 if you need further information.