GULF SOUTH HEALTH PLANS' MEMBERS' RIGHTS AND RESPONSIBILITIES STATEMENT

As a member of Gulf South Health Plans, you have several rights you should be aware of, as well as several responsibilities in order for you to be ensured quality services. The Members' Rights and Responsibilities are reviewed annually and submitted to the Management Quality Initiative Committee for approval. Below you will find the current Members' Rights and Responsibilities approved by the Committee in December, 1996.

Please read them carefully so you will become a more informed user of your healthcare services.

You have the right

  • to be treated with respect and dignity. Your right to privacy will be recognized.
  • to receive information about the Health plan (Gulf South Health Plans), its benefits and services, its practitioners and providers. (Additional educational information on the practitioners is available upon request.)
  • to receive prompt, courteous assistance when requesting information.
  • to participate in decisions regarding your healthcare, giving informed consent prior to any treatment, unless your life and health are in serious danger.
  • to obtain current information by your physician of diagnosis, prognosis, and treatment plan in understandable terms.
  • to refuse treatment, to the extent provided by law, and be informed of possible consequences of your refusal.
  • to guaranteed confidentiality concerning medical information maintained at the Health plan. Written permission is required to release medical information except when:
    • information is requested by other health professionals for your care.
      the Health plan is legally obligated to release information.
    • the Health plan releases information in the form of statistical data that does not identify individual members.
    • information is necessary to facilitate claims payment, utilization management or quality management.
  • to express verbal or written complaints or appeals about the Health plan or the care provided, and to a timely response when appropriate. You may initiate the appeal/grievance procedure if you are dissatisfied with the Health plan's decision regarding your complaint.
  • to change your Primary Care Physician, subject to the Health plan's policy and procedure.

 

You have responsibilities both to yourself and to the Health plan including:

  • Selecting a Primary Care Physician (PCP).
  • Reading and understanding all materials distributed by the Health plan in order to comply with policies, procedures, benefits and services.
  • Providing complete and accurate information that the Health plan and its practitioners and providers need in order to care for you. This includes information regarding your medical records, eligibility, phone and address changes, and other health insurance.
  • Cooperating with practitioners and providers to help establish the proper patient/physician relationship, dealing in a courteous, respectful manner.
  • Scheduling and being on time for regular appointments. Calling the practitioner and provider if you must be late or cancel.
  • Contacting your PCP prior to seeking any services, except in a life or limb-threatening emergency. (You must notify your PCP within the time frame outlined in your policy to receive benefits for emergency care.)
  • Making sure you have all the information you need to give informed consent for a procedure or treatment and asking questions and understanding the answers concerning your treatment.
  • Following the treatment plans and instructions for care that you have agreed upon with your practitioner.
  • Carefully weighing the consequences of refusing to comply with physician instructions or treatment plans.
  • Making all appropriate payments when services are rendered.
  • Furnishing the Health plan with any medical records and/or documentation needed to process a complaint or appeal of a denied claim. Written permission is required to release medical information except when:
    • information is requested by other health professionals for your care.
    • the Health plan is legally obligated to release information.
    • the Health plan releases information in the form of statistical data that does not identify individual members.
    • information is necessary to facilitate claims payment, utilization management or quality management.
  • Furnishing the Health plan with any medical records and/or documentation needed to process a complaint or appeal of a denied claim.