Important Information

As a member of CoOportunity Health, you are entitled to certain rights and services. Similarly, you have a responsibility to participate in your healthcare. A good partnership between you, your healthcare provider, and CoOportunity Health will enhance your ability to receive the maximum benefit from your health plan. Here is a summary of your rights and responsibilities:

Members have the Right to:

1. Receive information about their health insurance plan, their practitioners and providers, and members’ rights and responsibilities.

2. Courteous treatment. We respect your right to:

• Be treated with respect and recognition of your dignity. We will not discriminate on the basis of race, religion, national origin, sex, age, sexual preference, type of illness, physical or mental disability, or financial status.
• Be addressed in a manner that is comfortable to you.
• Know your healthcare providers. You have the right to ask all personnel involved in your care to introduce themselves, state their positions and explain what they are going to do for you.

3. Available and accessible services, including emergency services. Responsibility for payment for such services will be determined by your plan’s coverage provisions.

4. Privacy. Plan providers are required to respect the privacy of all members. Case discussions, examinations and treatment are confidential and conducted discreetly.

5. A candid discussion with a provider regarding appropriate or medically-necessary treatment options for a specific condition, regardless of cost or plan coverage provisions.

6. Be informed about their healthcare and to receive information about proposed treatments and alternatives.

7. An explanation from healthcare provider(s) regarding:

• Diagnosis
• Recommended treatment and alternatives to treatment
• Potential outcomes and/or prognosis
• Significant benefits and risks of each alternative

8.  Include family members or friends in discussions and decisions related to their healthcare and healthcare coverage, and allow them to receive information on the member’s behalf if appropriate permissions have been granted.

9.  Designate others, through written power of attorney, to assist them in making important medical decisions when they are incapacitated.

10. Participate with providers in making decisions about their care. These rights generally include:

• Giving informed consent, i.e., agreeing to treatment based on a full explanation of a disease and the risks and benefits of proposed treatment, as well as alternative treatments
• Refusing diagnostic procedures or treatment. It is your right to decide whether you wish to be treated and, if so, by which method of treatment.

• You may be treated without consent under certain circumstances, including in an emergency and when immediate action must be taken. The consent of a legal guardian may be required if you are a minor, unconscious or unable to give consent.

11.  To make individual decisions based on your personal beliefs and values as well as on the available medical information that you may be faced with making critical treatment choices while you are under the care of a healthcare provider. We respect your right..

12. Appropriate confidentiality of all medical and financial records in accordance with state and federal law. Generally, your medical records will not be released to anyone unless you grant permission in writing, or we are required or permitted, under applicable law, to use or release this information. Certain examples of permitted releases of information are:

• Where required by a court order
• To medical personnel in a medical emergency
• As necessary to facilitate complaint investigations or inspections by state regulatory authorities, CMS or the U.S. Inspector General
• To qualified personnel for research, audit or program evaluation, as long as individuals cannot be identified

13. Voice complaints or submit appeals about their health plan or the care provided under their plan.

14. Make recommendations regarding member rights and responsibilities.

Members have the Responsibility to:

1. Be honest and to provide, to the extent possible, complete information that the health plan needs to administer plan benefits and its providers need to provide care. It is essential that a Member provide an accurate and complete medical history. Tell those who are caring for you exactly how you feel about the things that are happening to you.

2. Ask for clear explanations. If the explanation of your medical problem or treatment plan is not clear, ask for the information you need. You may also want to ask:

• Why a treatment is recommended
• What alternatives are available
• If the treatment is new or experimental
• If the treatment causes discomfort or pain
• How long the treatment will take
• What risks or side effects are involved
• About the credentials of the person providing treatment

3. Understand their health problems and to participate in developing mutually agreed upon treatment goals to the greatest degree possible. Once a member has agreed upon a treatment plan, it is the member’s responsibility to follow the prescribed plan and instructions for care. It is your responsibility to advise the healthcare provider treating you if you are unable to follow a treatment plan.

4. Make informed decisions. Because you are responsible for the decisions you make about your care, we encourage you to gather as much information as you need to make your decisions.  You have the responsibility to ask questions of your healthcare provider when you do not fully understand the information shared with you about your health status or treatment recommendations and options. You may be asked to consent in writing to certain tests, procedures or operations. Ask as many questions as are needed to fully understand each document you are asked to sign. If you change your mind or refuse a treatment, discuss your reasons with your healthcare provider.

5. Report changes in their health. Tell your healthcare provider about any changes in your health.

6. Know their medications. Know or write down the names and purposes of the medications you are taking or have taken recently.

7. Know their providers. Try to know the names and the positions of everyone who cares for you (doctors, dentists, nurses, etc.). Also, know the names and addresses of your previous healthcare providers.