As a member of the HMO health plan, you have certain rights and responsibilities when receiving health care services and should expect the best possible care available. We have provided the following information so you can be an informed customer and active participant in your health care program.
Membership
You have the right to:
- You have the right to select and/or change your Primary Care Physician (PCP), and know the qualifications, titles and responsibilities of the professionals responsible for your health care.
- You have the right to be provided with information about: your HMO; health care benefits; copayments, limitations and/or other charges; service access; changes and/or termination in benefits and participating providers; and limitations.
- You have the right to receive prompt and appropriate treatment for physical or emotional disorders and participate with your providers in decisions regarding your care.
- You have the right to express opinions, concerns, complaints and appeals regarding any aspect of the HMO program in a constructive manner.
- You have the right to be treated with dignity, compassion and respect for your privacy.
- You have the right to receive timely resolution of complaints or appeals through Customer Service and the HMO complaint procedure.
- You have the right to have all medical and other information held confidential unless disclosure is required by law or requested in writing by you.
- You have the right to have access to review by an Independent Review Organization.
- You have the right to make recommendations regarding your HMO Blue Texas rights and responsibilities policies.
- You have the right to refuse treatment and be informed of the medical consequences as a result of this decision.
- You have the right to have a candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage.
Membership
You have the responsibility to:
- You have the responsibility to meet all eligibility requirements of your employer and the Health Maintenance Organization (HMO).
- You have the responsibility to identify yourself as an HMO member by presenting your ID card and pay the copayment at the time of service for network benefits.
- You have the responsibility to establish a physician/ patient relationship with your Primary Care Physician (PCP) and seek your PCP's medical advice/ referral for network services prior to receiving medical care, unless it is an emergency situation or services are performed by your HMO participating OB/GYN.
- You have the responsibility to provide, to the extent possible, information that the HMO and practitioner/providers need, in order to care for you, including changes in your family status, address and phone numbers within 31 days of the change.
- You have the responsibility to understand the medications you are taking and receive proper instructions on how to take them.
- You have the responsibility to notify your primary care physician or HMO plan within 48 hours or as soon as reasonably possible after receiving emergency care services.
- You have the responsibility to communicate complete and accurate medical information to health care providers.
- You have the responsibility to call in advance to schedule appointments with your network provider and notify them prior to canceling or rescheduling appointments.
- You have the responsibility to read your coverage documents for information about benefits, limitations, and exclusions.
- You have the responsibility to ask questions and follow instructions and guidelines given by your provider to achieve and maintain good health.
- You have the responsibility to understand your health problems and participate to the degree possible in the development of treatment goals mutually agreed upon between you and your provider.
