Highlands Wellmont Health Network Member Rights and Responsibilities

You have the right to:

  • Obtain appropriate health care and preventive services from your Primary Care Physician, Specialist Physician, Hospital, and other Health Care Providers.
  • Receive professional, courteous and considerate treatment from all participating providers and health plan staff with recognition of your dignity and need for privacy.
  • Receive information about the health plan, its services and the health care practitioners providing care.
  • Confidentiality of your health care information concerning medical records and the physician-patient relationship except when and to the extent release is required by law or to assure that high quality medical care is delivered to members of the network.
  • Participate in decision-making regarding your health care.  This includes the right to accept or refuse medical or surgical treatment and to direct the types of health care you may receive if you become unable to express your wishes.  This can be exercised by talking to your physician about advance directives or living wills. 
  • Obtain care for a life-threatening emergency or a medical situation that requires a physician's immediate attention by going to the nearest physician's office or emergency room for care when temporarily out of the service area.
  • Have access to emergency health care services 24 hours a day, 365 days a year.
  • Receive information regarding the health plan's appeal, complaint, and grievance processes
  • Voice grievances concerning the health plan or care received

You have the responsibility to:

  • Choose a Primary Care Physician and immediately establish an ongoing patient-doctor relationship with your Primary Care Physician
  • Obtain medical care, which is performed, prescribed, and directed by your Primary Care Physician and/or the health plan and provided by participating providers
  • Carry your health care identification card at all times, presenting the card to the person in charge of billing at the provider's facility's office
  • Notify the health plan within 24 hours (or as soon as medically possible) after receiving out-of-network emergency or urgent care
  • Provide, to the extent possible, information needed by providers in order to care for the member, including reports of immunizations, medical conditions, medications, present complaints, past illnesses, hospitalizations, living will, and other matters relevant to care
  • Follow instructions and guidelines given by those providing your health care services.  Failure to work cooperatively with your health care provider may result in dismissal from  his/her practice.
  • Provide information concerning any other insurance coverage in effect for the member or member's spouse at enrollment and report any changes in that coverage to the health plan
  • Show consideration and respect to providers, provider staff, and health plan staff
  • Make copayments for health care received as required by your health plan
  • Seek assistance from your health plan staff concerning any clarification necessary in order to assess your health insurance benefits and specialty services