STAGE DEV MAY, 2013

CCHP Member Rights & Responsibilities

CCHP Member Rights & Responsibilities

All CCHP Members have the right to:  

  1. Courteous and considerate treatment; to be treated with respect and recognition of their dignity and right to privacy.
  2. Receive information about CCHP, its services, its practitioners / providers, and members’ rights and responsibilities.
  3. Make recommendations regarding CCHP’s member rights and responsibilities policy.
  4. Be informed about their available health plan benefits, including a clear explanation about how to obtain services.
  5. Receive appropriate preventive health services as indicated in their Evidence of Coverage (EOC).
  6. Receive upon request, names, specialties and titles of the professionals responsible for their care.
  7. Amend their own health care information that CCHP has when they consider it is incorrect or incomplete.
  8. Participate with practitioners in the decision making regarding their health care.
  9. Inspect and copy their own medical information used to make decisions about their health care.
  10. Request a confidential or candid discussion with CCHP’s qualified Medical Management staff regarding ones health matter and appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
  11. Receive reasonable information regarding the risk for a given treatment, the length of disability and the qualifications of the care provider prior to giving consent for any procedure.
  12. Additional medical or surgical opinions from out-of–network providers, in situations when your treating physician or the Plan feels this would be helpful in determining a diagnosis or course of treatment (with an approved referral).
  13. Be represented by parents, guardians, family members or other conservators for those who are unable to fully participate in their treatment decisions.
  14. Be fully informed of CCHP’s grievance procedure and how to use it without fear of prejudicial treatment from their health care provider.
  15. Voice complaints or appeals about CCHP or the care provided.
  16. A timely response to request for services, complaints and inquiries regarding their health benefits and services.
  17. Request a copy of CCHP’s Notice of Privacy Practices.

Members are responsible:

  1. For knowing and understanding their health benefits and services and how to obtain them.
  2. For contacting their physician or CCHP coordinator with any questions or concerns regarding health benefits or services.
  3. To provide, to the extent possible, information that CCHP and its practitioners / providers need in order to care for them.
  4. To understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
  5. For cooperating with those providing health care services; however, they have the right to refuse medical treatment.
  6. To follow the plans and instructions for care that they have agreed upon with their practitioners.
  7. To provide CCHP with information when another source responsible to pay for health care is involved, such as liability insurance after an accident. In these cases, members have the responsibility to cooperate with their health plan for proper reimbursement of injury treatment by the other source to their health plan.

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