Members' Rights and Responsibilities - Behavioral Health Services

Members' Rights - Behavioral Health Services

People receiving HMSA behavioral health services have the following rights in addition to HMSA members' rights:

• To be treated with respect and dignity.
• To be treated as an individual with personal needs, feelings, preferences, and requirements.
• To receive nondiscriminatory care, services, and access to treatment, regardless of race, religion, gender, ethnicity, sexual orientation, age, or disability.
• To receive communication from behavioral health services staff and providers in a language the member understands. If necessary, interpretation services will be provided free of charge to the member.
• To establish advanced medical directives, health care proxies, and powers of attorney for health care.
• To know what health care benefits are available, how those benefits are administered, and what the costs are as related to financial obligations (e.g., copayment and coinsurance).
• To be informed of the names, specialties, and qualifications of health care physicians (or other allied health care professionals) involved in the member's care.
• To receive accurate and easily understandable information to help them make informed decisions about their health care. This includes a candid discussion of all services available or that might be appropriate, regardless of whether those services are covered by current benefits. 
• To be fully informed about any procedures, medications (including their benefits and risks), or research projects that the member may become involved in before they are started.
• To fully participate in the development of a plan for treatment that is customized for the member and to receive a copy of this plan upon request. If the member is unable to fully participate in treatment decisions, they have the right to be represented by family members, guardians, and/or other conservators.
• To refuse any treatment without losing access to other services to the extent permitted by law and to be informed of the consequences of this refusal. However, the member's provider has the right to discontinue treatment with them if the provider feels that the refusal of treatment makes reasonable and responsible treatment impossible.
• To receive continuous care with the provider(s) of the member's choice as long as the member remains eligible for services (see Continuity of Care - Behavioral Health). If it becomes necessary to transfer a member's care to another provider, the member will be given advance notice, including the reasons for transfer, any alternatives, and a plan for the transfer unless an emergency situation exists.
• To receive prompt and reasonable responses to questions and requests.
• To receive information about the processes and clinical guidelines that HMSA uses to make decisions about a member's coverage, benefit plan eligibility, benefit plan services, copayments, providers available for care, the availability of preventive health services, claims filing, and appeals.
• To file an appeal with HMSA (or the appropriate governmental agency) when a decision has been made to deny treatment and have a doctor who was not involved in the original decision review the appeal (see Appealing a Precertification Denial or Concurrent Review).
• To be fully informed of any rules and regulations that may govern a member's participation in treatment, including resources and regulations protecting their rights.
• To be informed of the complaint/grievance procedures and be able to voice their opinions, recommendations, or complaints and make appeals about policies, decisions, or a member's care to HMSA without fear of discrimination or reprisal.
• To receive full consideration of privacy and confidentiality of all information recorded in a member's treatment files (see Confidentiality of Medical Information). No information about a member or their health care will be disclosed, other than to their insurance company, without written consent or as required by state and/or federal laws.

Members' Responsibilities - Behavioral Health Services

Members receiving HMSA's behavioral health services have the following responsibilities in addition to HMSA members' responsibilities:

• To provide complete and accurate information to HMSA, its practitioners, and providers. This ensures members are provided with quality services.
• To be an active participant in their treatment planning and recovery process.
• To follow the plans and instructions for care that they have agreed upon with their practitioners.
• To know how to access behavioral health care services in routine, urgent, and emergency situations.
• To make known questions, complaints, comments, problems, and suggestions regarding health care service delivery.
• To request information and referrals in regard to health care or health care benefits.

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