For Patients & Members

Patient/Insured Rights and Responsibilities

As a PPO Network, Midlands Choice encourages all of our providers to build strong relationships with their patients. Midlands Choice also strongly reinforces and encourages the use of the Patients'/Insureds' Bill of Rights and Responsibilities in daily practice to promote health care quality and value and protect consumers and workers in the health care system.

The Patients'/Insureds' Bill of Rights and Responsibilities has three goals:

  • To strengthen patient/insured confidence that the health care system is fair and responsive to consumer needs
  • To reaffirm the importance of a strong relationship between patients/insureds and their health care providers
  • To reaffirm the critical role patients/insureds play in safeguarding their own health.

Patients'/Insureds' Rights

  • The Right to Information - Patients/insureds have the right to receive accurate, easily understood information to assist them in making informed decisions about health care, facilities, and professional services.
  • The Right to Choose - Patients/insureds have the right to a choice of health care providers that is sufficient to assure access to appropriate high-quality health care. This right includes giving women access to qualified specialists such as obstetricians and gynecologists and giving patients/insureds with serious medical conditions and chronic illnesses access to specialists.
  • The Right to Access Emergency Services - Patients/insureds have the right to access emergency services when and where the need arises. Health plans should provide payment when a patient/insured presents himself/herself to any emergency department for treatment of an emergency medical condition, regardless of whether that emergency department is in the health plan's network.
  • The Right to Full Partnership in Health Care Decisions - Patients/Insureds have the right to fully participate in all decisions related to their health care. Patients/insureds who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Additionally, provider contracts will not contain any so-called "gag clauses" that restrict health professionals' ability to discuss and advise patients/insureds on medically necessary treatment options.
  • The Right to Care Without Discrimination - Patients/insureds have the right to considerate, respectful care from all members of the health care industry at all times and under all circumstances. Patients/insureds must not be discriminated against in the provision of health care services, consistent with the benefits covered in their policy and/or as required by law, based on race, ethnicity, national origin, religion, sex, age, current or anticipated mental or physical disability, sexual orientation, genetic information, or source of payment.
  • The Right to Privacy - Patients/insureds have the right to communicate with health care providers in confidence and to have their health information protected in accordance with applicable privacy laws. Patients/insureds also have certain rights under the Health Insurance Portability and Accountability Act of 1996 regarding the control and accuracy of their health information, including the right  to review and copy their own medical records and certain disclosures of their medical records, the right to request specific means of communication and request amendments to their records.
  • The Right to Speedy Complaint Resolution - Patients/insureds have the right to a fair and efficient process for resolving differences with health care providers and the institutions that serve them, including a rigorous system of internal review and an independent system of external review.

Patients'/Insureds' Responsibilities

  • The responsibility to provide correct and complete information about their health and past medical history.
  • The responsibility to report changes in their general health condition, symptoms or allergies to the responsible health care provider.
  • The responsibility to alert or report to their health care provider any time they do not understand the planned treatment or their part in the plan.
  • The responsibility to follow the recommended treatment plan they have agreed to, including instructions from nurses and other health care personnel.
  • The responsibility for any consequences that result from refusing the planned treatment.
  • The responsibility to keep appointments with their health care providers.
  • The responsibility to treat others with respect.
  • The responsibility to pay their share of their health care expenses.
  • The responsibility to respect the property and rights of others.

Patients'/Insureds' Complaints

Midlands Choice supports and maintains a venue by which patients have the right to file a complaint or grievance and have it resolved in a timely manner.

Issues with a Provider
To file a complaint regarding quality of care from a network provider, access to a provider's office, dissatisfaction with office staff or provider services, provider billing or provider coverage in a geographic area, contact customer service or complete a Complaint Form.

Issues with Midlands Choice
If you have a complaint regarding the performance of or service from an employee of Midlands Choice, including inappropriate behavior, timely response to complaints or requests for information, e-mail Human Resources.