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Medicaid : Rights and Responsibilities

Your Rights



As a member of Harmony Health Plan you have the following rights:



  • To be treated with respect and recognition of your dignity and your right to privacy.  To be treated with courtesy by your PCP, all office staff members and staff members of Harmony Health Plan.
  • A right to receive information about the organization, its services, its practitioners, and provider and member rights and responsibilities.
  • A right to participate with providers in making decisions about your health care.
  • A right to a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
  • A right to make recommendations regarding the organizations member rights and responsibilities policy.
  • To choose your own doctor within the Harmony Health Plan network.
  • To be told about your treatment plan, before treatment begins.
  • To receive care consistent with sound nursing and medical practices.
  • To refuse treatment to the extent of the law and to be told of the outcome.
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • To voice concerns, complaints or appeals about the organization and the care it provides and to receive prompt answers.
  • To request information relating to Harmony’s Physician Incentive Plan.
  • To request a description of the financial relationships between Harmony and any health care provider.
  • You can also ask for the percentage of total premiums spent on health care related expenses and the percentage of total premiums spent on other expenses, including administrative expenses.
  • You have the right to request the following information from Harmony’s participating health care providers:
    • Copy of the total bill for services you received from your health care provider.
    • Educational background, experience, training, specialty and board certification.
    • The names of the licensed facilities in Harmony’s network where the health care provider presently has privileges for the treatment, illness or procedure you are inquiring about.
    • Information about the health care provider’s participation in continuing education programs.
    • Compliance with licensure, certification or registration requirements.



 

Your Responsibilities



  • As a member of Harmony Health Plan you have the following responsibilities:
  • To treat your PCP and office staff with courtesy and respect.
  • A responsibility to supply information  (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
  • A responsibility to follow plans and instructions for care that they have agreed to with their practitioners and providers.
  • A responsibility to understand their health problems and participate in developing mutually agreed upon treatment goals, to the degree possible.
  • to decide about having medical treatment or procedure before it begins.
  • To help your PCP obtain your medical records.
  • To not seek care from a specialist, unless referred by your PCP.
  • To not seek care in an emergency room for conditions that are not life-threatening without contacting your PCP.
  • To keep all scheduled appointments and be on time.
  • To follow the rules and regulations of Harmony Health Plan.

Last modified: 10/04/2012