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Member Rights and Responsibilities

The following outlines the rights and responsibilities of SelectHealth members and is meant as a general overview for provider offices.

 

ADVANCE DIRECTIVES

Advance Directives are documents signed in "advance" which state a member's legally valid choices about medical treatment or name a specific person to make decisions about his/her medical treatment when the member is unable to make those decisions or choices by themselves. Physicians should encourage members to complete an Advance Directive prior to care. Please see the following links for additional information and documentation regarding Advance Directives.

 

Advance Directive Fact Sheet

Advance Directive Fact Sheet - Spanish

Advance Care Planning Information and Documentation

Advance Care Planning Information and Documentation - Spanish

 

MEMBER RIGHTS


All SelectHealth members have the right to:

 Review and obtain a copy of your policy and member records, subject to state law, and our policies and

    procedures.

 Receive information about our services, providers, and your member rights and responsibilities.

 Receive considerate, courteous care and treatment with respect for personal privacy and dignity.

 Receive accurate information regarding your rights and responsibilities and benefits in member materials and 

    through telephone contact.

 Be informed by your provider about your health so you can make thoughtful decisions before you receive

    treatment.

 Candidly discuss with your healthcare provider appropriate or medically necessary treatment options for your 

    condition, regardless of cost or benefit coverage. We do not have policies that restrict dialogue between 

    provider and patient, and we do not direct providers to restrict information regarding treatment options.

 Participate with providers in decisions involving your health and the medical care you receive.

 Express concerns about SelectHealth and the care we provide and receive a response in a reasonable period

    of time.

 Request a second opinion.

 Refuse recommended medical treatment to the extent permitted by law.

 Select or change your primary care provider.

 Make recommendations regarding our Member Rights and Responsibilities policy.

 Have reasonable access to appropriate medical services, regardless of your race, religion, nationality, disability,

    sex, or sexual preference and 24-hour access to urgent and emergency care.

 Receive care provided by or referred by your primary care provider.

 Have all medical records and other information kept confidential.

 Have all claims paid accurately and in a timely manner.


MEMBER RESPONSIBILITIES


All SelectHealth members have the responsibility to:

•  Treat all providers and personnel at SelectHealth courteously.

 Read all plan materials carefully as soon as you enroll and ask questions when necessary.

 Ask questions and make certain you understand the explanation and instructions you are given.

 Understand the benefits of your plan and understand not all recommended medical treatment is eligible for

   coverage.

 Follow plans and instructions for care that have been agreed upon with your provider.

 Express constructively your opinions, concerns, and complaints to the appropriate SelectHealth staff.

 Follow the policies and procedures of your plan, and when appropriate, seek a referral from your primary care

    provider to SelectHealth providers or call us for assistance.

 Ask questions and understand the consequences of refusing medical treatment.

 Communicate openly with your healthcare provider, develop a patient-provider relationship based on trust and

    cooperation, and participate in developing mutually agreed-upon treatment goals.

 Read and understand your plan benefits and limitations and call us with any questions.

 Keep scheduled appointments or give adequate notice of cancellation.

 Obtain services consistently according to the policies and procedures of your plan.

 Provide all pertinent information needed by your provider to assess your condition and recommend treatment.

 Use our providers when applicable, carry your ID Card, and pay copay/ coinsurance amounts at the time of

    service.

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