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Members' Rights and Responsibilities

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First Priority Health is committed to providing members with the highest quality care possible. All First Priority Health staff is dedicated to serving our members in a manner that respects their rights as individuals and maintains confidentiality about personal medical matters. We encourage members to know and exercise their rights and responsibilities, as follows:

As a Child or Parent, You Have:

  • The RIGHT to timely and effective redress of complaints, grievances and appeals about First Priority Health or the care provided.
  • The RIGHT to receive health maintenance organization literature and materials for your use written in a manner that truthfully and accurately provides relevant information that is easily understood by a person of average intelligence. This literature and materials should include information about the managed care organization, its services, its practitioners and providers and member children’s rights and responsibilities.
  • The RIGHT to participate with practitioners in decision making regarding your child’s health care.
  • The RIGHT to a candid discussion of appropriate or medically necessary treatment options for your child’s condition, regardless of cost or benefit coverage.
  • The RIGHT to obtain from your child’s physician, unless it is not medically advisable, complete, current information concerning the diagnosis, treatment and prognosis in terms that you can reasonably be expected to understand.
  • The RIGHT to be given the name, professional status and function of any personnel providing health services to your child.
  • The RIGHT to give informed consent before the start of any procedure or treatment.
  • The RIGHT to be advised if a health care facility or any of the providers participating in your child’s care propose to engage in or perform human experimentation or research affecting your child’s care or treatment. You or a legally responsible party on your child’s behalf may, at any time, refuse to participate in or to continue in any experimentation or research program to which you have previously given informed consent.
  • The RIGHT to refuse drugs, treatment or other procedures offered to your child by the health maintenance organization or its providers to the extent permitted by law, and to be informed by a physician of the medical consequences of your refusal of any drugs, treatment or procedures.
  • The RIGHT to have records pertaining to your child’s medical care treated as confidential unless disclosure is necessary to interpret the application of the contract to your child’s care or unless disclosure is otherwise provided for by law.
  • The RIGHT to information contained in your child’s medical records unless access is specifically restricted by the attending physician for medical reasons.
  • The RIGHT to obtain emergency services with out unnecessary delay, when they are necessary.
  • The RIGHT to be treated with respect and recognition of your dignity and right to privacy.
  • The RIGHT to be informed of these rights and responsibilities.
  • The RIGHT to make recommendations regarding the organization’s members’ rights and responsibilities policies.

As a Child or Parent, You Have:

  • The RESPONSIBILITY to provide, to the extent possible, information that First Priority Health and its practitioners and providers need in order to care for your child. You should communicate openly with the physician you choose by developing a physician–patient relationship based on trust and cooperation.
  • The RESPONSIBILITY to choose a PCP and keep him/her abreast of your child’s medical care.
  • The RESPONSIBILITY to maintain your child’s health and prevent illness, and to follow the plans and instructions for care that you have agreed on with your child’s practitioner.
  • The RESPONSIBILITY to ask questions to make certain you understand the explanations and instructions given to you.
  • The RESPONSIBILITY to understand the potential consequences if you refuse to comply with treatment plans or recommendations.
  • The RESPONSIBILITY to keep scheduled appointments or give adequate notice of delay or cancellation.
  • The RESPONSIBILITY to follow the rules of membership and to read all materials carefully upon enrollment.
  • The RESPONSIBILITY to communicate pertinent information to your child’s PCP about his/her health and seek health care before a problem becomes serious.
  • The RESPONSIBILITY to express your opinions, concerns or complaints on the services provided in a constructive manner to the appropriate people within the Plan.
  • The RESPONSIBILITY to understand your health problems and participate in developing mutually agreed-upon treatment goals to the greatest degree possible.