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Member Rights and Responsibilities

THPPO Members have the right to:

  • Expect THPPO to be responsible for providing the Member Rights and Responsibilities policy to all participating providers.
  • Information about THPPO, its services, the practitioners providing care and member rights and responsibilities.
    • Know what provider incentives and restrictions might influence practice patterns.
    • Useful information about provider options.
    • Timely access to care.
  • Voice complaints and grievances about BHP or care provided and to receive a timely response to such complaints and grievances.
  • Participate in decision-making regarding their health care including the right to make an Advance Directive (Living Will and/or Durable Health Care Power of Attorney).
    • Sufficient information to enable him/her to make an informed decision regarding choices in treatment of care and of providers (informed consent).
    • To accept or refuse treatment.
  • Practitioners/providers who effectively understand and relate medical care delivered to or recommended to him/her.
  • Have THPPO promote the philosophy with its providers that care, activities and information should be coordinated among the providers, either personally or in a constructive and timely manner, for the provision of and continuity of care for the member's benefit.
  • Have all necessary and appropriate information regarding a member's condition and treatment provided to the consulting or referred provider to minimize unnecessary testing or repetition of diagnostic procedures and for the provision of and continuity of care. This includes, but is not limited to, records of clinical findings and/or recommendations for care and treatment.
  • Have providers access other health care providers as necessary to meet his/her needs.
  • Appeal any decision or plan of treatment that may be denied.
  • Be treated with consideration, respect and full recognition of his/her dignity and individuality including the need for privacy by all providers of care and services.
  • Expect that patient information and records be kept confidential and protected from unauthorized or inadvertent disclosure.
  • Approve or refuse the release of identifiable personal information, except when such release is required by law or is required for continuity of care.
  • Be provided with complete and understandable information about services available, access to other services, charges and scheduling.
  • Be informed of the results of assessments resulting from participation in surveys about complaints, satisfaction, enrollment and disenrollment.

THPPO Members are responsible for:

  • Providing, to the extent possible, such information as is necessary to receive health care services, including completing those forms as requested by providers such as History of Present Illness and Past Medical, Social, and Family Histories.
  • Following the instructions and guidelines given by those providing health care services unless he/she changes the agreement with the provider.
  • Acting in a considerate and cooperative manner when interacting with THPPO providers and their staff, as well as with the THPPO and Medicus Resource Management staffs.
  • Understanding the benefits and services provided by their coverage and reading their Explanation of Benefits for their responsibilities regarding payment of services.
    • This includes but is not limited to precertifying care and procedures when necessary.
  • To assist the organization in gathering data regarding member complaints and grievances, degree of satisfaction or dissatisfaction, enrollment and disenrollment that affect the member and those providing or assisting with care.
  • Expressing opinions, concerns, or complaints in a constructive manner.