Members have the right to:

• Receive information about the group, the services it provides, its practitioners and health care providers, and member rights and responsibilities.
• Be treated with respect and recognition of their dignity and privacy.
• Be involved with doctors in decisions about their health care.
• To hear a frank discussion of treatment options that are necessary or appropriate for their health condition, regardless of cost or whether they are covered by insurance.
• To voice complaints or appeals about the complex or the care provided by the complex.
• Provide input into the policies regarding the rights and responsibilities of members of the association.

Responsible members:

• Provide information (to the extent possible) that the health care team and its practitioners and providers need to care for patients.
• Follow the care plan and instructions they have agreed upon with their doctor.
• Understand their health problems and participate in developing mutually agreed treatment goals to the extent possible.

• Utilization Management decisions are based solely on the appropriateness of care and services and whether services are insured. The organization does not reward practitioners or other individuals for withholding payment or services. Monetary incentives for utilization management decision makers discourage decisions that lead to low utilization.
• If you would like a copy of the criteria used to determine and approve your health care services, please contact the Member Services Department at (800) 611-0111. The group is only required to provide criteria or rules for the specific procedures or conditions requested.