Your Rights and Responsibilities

Bill of Rights

Rights
As a PPO member, you are entitled to:

Receive medically necessary and appropriate care in the most appropriate setting as defined in the benefit plan
Receive information about health care benefits, PPO services, practitioners and quality improvement programs in clear and understandable terms
Participate in health care decision-making to accept or refuse a prescribed treatment, or discuss with your health care practitioner alternative treatment regardless of cost or availability of a payable benefit
File complaints and appeals relating to the provision or payment of health care services
Receive considerate, courteous and prompt care, with respect for your confidentiality, privacy and dignity, from BCBSM PPO network practitioners and all BCBSM staff
Make recommendations regarding the organization's enrollee rights and responsibilities policies
Review your medical records
Have your medical records kept confidential in accordance with state and federal privacy laws

Responsibilities
Your responsibilities:

Follow instructions and guidelines prescribed by your physician and other health care professionals
Keep your medical appointments and give timely notice to your health care practitioner if you have to reschedule
Provide to the extent possible complete information to your health care practitioners
Pay all applicable copayments and deductibles directly to your network practitioner
Follow your PPO's rules with regard to receiving care from network practitioners and obtaining provider referrals or plan authorizations if out-of-network care is necessary
Supply information (to the extent possible) that the organization and its practitioners need in order to provide care
Understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible