| Your Rights |
| You have the right to select and/or change your Primary Care Physician (PCP), and know the qualifications, titles and responsibilities of the professionals responsible for your health care. |
You have the right to be provided with information about: your HMO; health care benefits; copayments, copayment limitations and/or other charges; service access; changes and/or termination in benefits and participating providers; exclusions and limitations. |
| You have the right to receive prompt and appropriate treatment for physical or emotional disorders and participate with your providers in decisions regarding your care. |
You have the right to express opinions, concerns, complaints and appeals regarding any aspect of the HMO program in a constructive manner. |
| You have the right to be treated with dignity, compassion and respect for your privacy. |
You have the right to receive timely resolution of complaints or appeals through Customer Service and the HMO complaint procedure. |
| You have the right to have all medical and other information held confidential unless disclosure is required by law or requested in writing by you. |
You have the right to have access to review by an Independent Review Organization. |
| You have the right to make recommendations regarding your HMO Blue Texas rights and responsibilities policies. |
You have the right to refuse treatment and be informed of the medical consequences as a result of this decision. |
You have the right to have a candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage.
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| Your Responsibilities |
| You have the responsibility to meet all eligibility requirements of your employer and the Health Maintenance Organization (HMO). |
You have the responsibility to identify yourself as an HMO member by presenting your ID card and pay the copayment at the time of service for network benefits. |
| You have the responsibility to establish a physician/ patient relationship with your Primary Care Physician (PCP) and seek your PCP's medical advice/ referral for network services prior to receiving medical care, unless it is an emergency situation or services are performed by your HMO participating OB/GYN. |
You have the responsibility to provide, to the extent possible, information that the HMO and practitioner/providers need, in order to care for you, including changes in your family status, address and phone numbers within 31 days of the change. |
| You have the responsibility to understand the medications you are taking and receive proper instructions on how to take them. |
You have the responsibility to notify your primary care physician or HMO plan within 48 hours or as soon as reasonably possible after receiving emergency care services. |
| You have the responsibility to communicate complete and accurate medical information to health care providers. |
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| You have the responsibility to call in advance to schedule appointments with your network provider and notify them prior to canceling or rescheduling appointments. |
You have the responsibility to read your coverage documents for information about benefits, limitations, and exclusions. |
| You have the responsibility to ask questions and follow instructions and guidelines given by your provider to achieve and maintain good health. |
You have the responsibility to understand your health problems and participate to the degree possible in the development of treatment goals mutually agreed upon between you and your provider. |
