We pledge to treat our members with respect. As a QualChoice member, you have the right to:

  1. Information about QualChoice and its services.
  2. Access to health care providers in your plan’s network.
  3. Timely processing of claims, according to industry standards.
  4. Facts about how your claims were paid or denied. (Explanation of Benefits or EOB).
  5. Facts about your health, your care and likely outcome from a doctor or health expert in terms you can understand.
  6. Appoint another person to view and receive facts about your care.
  7. Information about treatment choices, no matter what the cost or benefit coverage.
  8. Know the name, title, and duties of any health care staff giving services to you.
  9. Work with health care experts in making your own health care choices.
  10. Emergency health care if you have a health problem that a reasonable person would believe needs immediate attention.
  11. Have all health care records treated as private unless the law allows them to be released.
  12. See all data in your health care records, subject to state and federal laws.
  13. Give your consent before the start of any surgery or care.
  14. Voice complaints and make appeals about QualChoice or your care, and receive a timely answer.
  15. Say no to any medicine, treatment or care from a network health care expert and to be informed of the health results and cost of refusing.
  16. Not be denied plan renewal based only on your health, as required by law.
  17. Be informed about and say no to any treatment that is experimental.
  18. Be informed of these rights and responsibilities.
  19. Give your opinion or suggest changes to our member rights and responsibilities policies.

 

You have the responsibility (duty) to:

  1. Give all facts needed for QualChoice and health care experts to give or arrange for care.
  2. Keep, or cancel in a timely way, all appointments with health care providers.
  3. Follow care plans that have been agreed on with your health care expert.
  4. Review your health plan and confirm benefits before receiving care.
  5. Show your ID card each time you get care.
  6. Discuss health care desires and/or concerns with doctors and other health care providers.
  7. Inform us of address or phone number changes so you can be sure of getting important messages.
  1. Use network doctors, facilities and other health care providers to receive full benefits.
  2. Pay any deductibles, copayments, or coinsurance amounts owed to health care providers.
  3. Learn about your health problems and take part in deciding on health care goals.