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1. Be treated without regard to race, ethnicity, national origin,
religion, sex, age, mental or physical disability, sexual
orientation, genetic information or source of payment.
2. Be treated in a
manner respectful to your personal privacy and dignity.
3. Receive
assistance in a prompt, courteous and responsible manner.
4. Receive a list
of participating providers.
5. Select a
primary care provider (PCP) or change your PCP, if necessary.
6. Knowledge of
the name of the physician who has primary responsibility for
coordinating your care and the names and professional
relationships of other physicians who will see you.
7. Be informed by
your treating provider of your diagnosis, prognosis and
treatment options in terms you understand, and regardless of
cost or benefit coverage.
8. Participate in
decisions regarding medical care, be advised by your treating
provider of the possible consequences of your decisions and
refusing treatment.
9. Have no
restrictions placed on any provider that precluded discussing
appropriate treatment options with you. Utilization Management
(UM) decisions are based on the appropriateness of care and
service required for each patient’s individual needs. We do not
compensate nor give incentives to physicians, UM staff or clinic
personnel for the denial of service or care.
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Requests for coverage of services are reviewed to determine that
the service is a covered benefit under the terms of the member’s
plan and that the service delivered is consistent with
established guidelines. In the event a request for coverage is
denied, the member, or a provider acting on behalf of the
member, may appeal this decision through the grievance process
and, depending on the specific circumstances, to an external
utilization review organization, which uses independent
physician reviewers, a governmental agency or the plan sponsor.
10. Be advised if
a physician proposes to engage in or perform human
experimentation affecting your care or treatment. The patient
has the right to refuse to participate in such research
projects.
11. Be referred,
according to your needs, to a provider suitable to care for your
condition.
12. Be assured of
confidential handling of all communication and medical
information as provided by law and professional medical ethics.
13. Express
concerns including quality of care issues, receiving a response
in a timely manner and initiating the grievance procedure
through your health plan if you are not satisfied with our
resolution of your complaint.
14. Receive
information about the clinic, its services, practitioners and
providers, and patients rights and responsibilities.
15. Make
recommendations regarding this patient rights and
responsibilities policy.
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