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Member Rights


Provider Administrative Policy

Section
Commercial Managed Care
Policy Date
April 2007
Status/Date
Reviewed/May 2008
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Member Rights

Quality Care
As a commercial managed care member, your patient has the right to:

  • A choice of a qualified contracting primary care physician (PCP).
  • A choice of a qualified contracting physician for annual gynecological exam related follow up and maternity care.
  • Self-referral for mammography and immunizations.
  • Candid discussion of appropriate or medically necessary treatment options for their condition regardless of cost or benefit coverage.
  • Timely access to the member’s PCP and specialists when medically necessary.
  • Receive emergency services when they, as a prudent layperson acting reasonably, would believe that an emergent medical condition existed. Payment will not be withheld in cases where the member seeks medically necessary emergency services.
  • Information about prescribed medications – what they are, how to take them and possible side effects.

Treatment with Dignity and Respect
As a commercial managed care member, your patient has the right to:

  • Be treated with dignity and respect and to have their right to privacy recognized.
  • Exercise these rights regardless of their race, physical or mental ability, ethnicity, gender, sexual orientation, creed, age, religion or their national origin, cultural or educational background, economic or health status, English proficiency, reading skills, or source of payment for their care. Expect these rights to be upheld by both the plan and contracting providers.
  • Confidential treatment of all communications and records pertaining to their care. They have the right to access their medical records. Blue Cross of Idaho must provide timely access to their records and any information that pertains to them. Except as authorized by state law, Blue Cross of Idaho and providers must get written permission from the member, or their authorized representative, before medical records can be made available.
  • Extend their rights to any person who may have legal responsibility to make decisions on their behalf regarding their medical care.
  • Refuse treatment or leave a medical facility, even against the advice of physicians (providing the member accepts responsibility and consequences of the decision).

Information on Medical Treatments and Insurance Coverage
As a commercial managed care member, your patient has the right to:

  • Receive information about an illness, the course of treatment and prospects for recovery in terms they can understand.
  • Reasonable continuity of care.

Timely Problem Resolution
As a commercial managed care member, your patient has the right to:

  • Make complaints and appeals without discrimination and expect problems to be fairly examined and appropriately addressed.
  • Have any information from their medical chart forwarded in a timely manner if needed for a complaint or appeal against Blue Cross of Idaho or the provider.
  • Responsiveness to requests made for services.

Policy History

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