Patient Bill of Rights
Notice to Exercise Rights
Consumers have the right to exercise his or her rights at any time, and to receive notice of rights in advance of receiving pre-planned care.
Patient Education and Patient Management Program
Consumers have the right to receive accurate, easily understood information about the Clinical Management Program and it’s characteristics. It is your right to request assistance in making informed health care decisions, health plans, professionals, and facilities in both written and verbal format. Consumers also have the right to receive education about the products and services to be provided in written and verbal format.
Choice of Providers and Plans
Consumers have the right to a choice of health care providers that is sufficient to ensure access to appropriate high-quality health care.
Continuity of Care
Consumers have the right to continuity of products and services and programs. It is also your right to receive information regarding changes in or termination of the Clinical Management Program.
Timely Provision of Care
Consumers have the right to receive products and services in a timely manner and in accordance with company policy.
The patient/patient’s designated representative is authorized to exercise their rights at any time.
Consumers have the right to identify the staff member of the program and their job title, and to speak with a supervisor of the staff member if requested. The consumer has the right to speak to a health professional at any time, if desired.
Access to Emergency Services
Consumers have the right to access emergency health care services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity — including severe pain — such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions
Consumers have the right and responsibility to fully participate in all decisions related to their health care. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators to include refusal of care, treatment and service.
Consumers have the right to be referred to another organization.
Participation in Program
Consumers have the right to decline participation, revoke consent or disenroll at any point in time from the program.
Refusal of Treatment
Consumers have the right to refuse all or part of the products and services and/or medical treatment provided even if it is recommended by their physician(s).
Respect and Nondiscrimination
Consumers have the right to be treated with dignity, respect, and to receive considerate, respectful care from all members of the health care system at all times and under all circumstances. Additionally, Consumers have the right to be free from abuse or exploitation of any kind. An environment of mutual respect is essential to maintain a quality health care system.
Confidentiality of Health Information
Consumers have the right to communicate with health care providers in confidence and to have the confidentiality of their individually identifiable health care information record and data protected and maintained. Consumers also have the right to review and copy their own medical records and request amendments to their records. It is also your right to have Personal Health information shared with the Clinical Management Program only in accordance with state and federal law.
Complaints and Appeals
All consumers have the right to a fair and efficient process for resolving differences with their health plans, health care providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. Consumers have the right to voice complaints/grievances to the company regarding treatment/care/service without fear of discrimination or reprisal for doing so.
Billing and Reimbursement
Consumers have the right to be informed verbally and in writing of billing and reimbursement methodologies prior to start of care and as changes occur, including fees for services/products provided, direct pay responsibilities, and notification of insurance coverage.
In a health care system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities. Greater individual involvement by consumers in their care increases the likelihood of achieving the best outcomes and helps support a quality improvement, cost-conscious environment.
Disclosure of Public Information: Upon request public information will be provided by HPC to the patient.
Responsibility of the Patient
As a patient, you have the responsibility to:
- Remain under a physician’s care while receiving services
- Notify physician if you participating in the Clinical Management Program
- Give accurate clinical and contact information and notify the Clinical Management Program of changes in this information
- Provide your health care providers with a complete & accurate health history
- Accept the consequences for any refusal of treatment or choice of non-compliance
- Participate in your plan of care and report any changes in your health status
- Sign the required consent form and release for insurance billing and submit any other forms that are necessary to participate in the program to the extent required by law, and ask questions about any documents that you do not understand
- Treat your health care provider personnel with respect and consideration
- Notify the health care provider of any problems with our care, without being subject to discrimination or reprisal
All patients should be guaranteed the following freedoms:
- To seek consultation with the physician(s) of their choice;
- To contract with their physician(s) on mutually agreeable terms;
- To use their own resources to purchase the care of their choice
- To be informed about their medical condition, the risks and benefits of treatment and appropriate alternatives;
- To refuse third-party interference in their medical care, and to be confident that their actions in seeking or declining medical care will not result in third-party- imposed penalties for patients or physicians;
To receive full disclosure of their insurance plan in plain language, including:
- CONTRACTS: A copy of the contract between the physician and health care plan, and between the patient or employer and the plan;
- COST: The full cost of the plan, including co-payments, coinsurance, and deductibles;
- COVERAGE: Benefits covered and excluded, including availability and location of 24-hour emergency care;
- QUALIFICATIONS: A roster and qualifications of participating health care providers;
- APPROVAL PROCEDURES: Authorization procedures for services, whether physician need approval of a committee or any other individual, and who decides what is medically necessary;
- REFERRALS: Procedures for consulting a specialist, and who must authorize the referral;
- APPEALS: Grievance procedures for claim or treatment denials.