|
|||
   |
|||
Patients' Rights
Suggestive Links:
The John Muir Physician Network Member Has the Right to:
- Exercise these rights without regard to gender, sexual orientation or cultural, economic, educational, physical/ mental disability, or religious background.
- Be provided with comprehensible information about the John Muir Physician Network, its services, physicians and the health care service delivery process. This information includes instructions on how to obtain care with various physicians and at varied facilities. Additionally, information will be included on how to obtain services outside the John Muir Physician Network system or service area.
- Be informed of emergent and non-emergent benefit coverage and cost of care, and receive an explanation of the member's financial obligations as appropriate, prior to incurring the expense (including co-payments, deductibles, and co-insurance).
- Be provided with information on how to obtain care after normal office hours and how to obtain emergency care including when to directly access emergency care or use 911 services.
- Examine and receive an explanation of bills generated for services delivered to the member.
- Be provided with information on how to submit a claim for covered services.
- Be informed of the name and qualifications of the physician who has primary responsibility for coordinating the member's care; and be informed of the names, qualifications, specialties of other physicians and nonphysicians who are involved in the member's care.
- Have 24-hour access to the member's primary care physician (or covering physician).
- Be treated with respect and dignity.
- Receive considerate and respectful care with full consideration of the member's privacy.
- Receive complete information about the diagnosis, proposed course of treatment or procedure, alternate courses of treatment or non-treatment, the clinical risks involved in each, and prospects for recovery in terms that are understandable to the member, in order to give informed consent or to refuse that course of treatment.
- Candidly discuss appropriate or medically necessary treatment options for the member's condition, regardless of cost or benefit coverage.
- Actively participate in decisions regarding the member's health care and treatment plan. To the extent permitted by law, this includes the right to refuse any procedure or treatment. If the recommended procedure or treatment is refused, an explanation will be given addressing the effect that this will have on the member's health.
- Receive confidential treatment of all member information and records used for any purpose.
- Be informed of applicable rules in the various health care settings regarding member conduct.
- Express opinions or concerns about the John Muir Physician Network or the care provided and offer recommendations for change in the health care service delivery process by contacting the John Muir Physician Network Customer Service Department.
- Be informed of the member complaint/grievance and appeal process including how to express a complaint or appeal.
- Be informed of the termination of a primary care physician or practice site and receive assistance in selecting a new primary care physician or site in this situation.
- Change primary care physicians by contacting the Health Plan Customer Service Department.
- Receive reasonable continuity of care and be given timely and sensible responses to questions and requests made for service, care and payment (including complaints and appeals).
- Be informed of continuing health care requirements following office visits, treatments, procedures and hospitalizations.
- Have all member rights apply to the person who has the legal responsibility to make health care decisions for the member.