For Patients & Members

Patient 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' 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.

As part of the services we offer with this in mind, we support and maintain a venue by which clients and consumers have the right to file a complaint or grievance and have it resolved in a timely manner.

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 geographical area, contact customer service or complete a Complaint Form.

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

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

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

Patients' Rights

  • The Right to Information - Patients 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 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 with serious medical conditions and chronic illnesses access to specialists.
  • Access to Emergency Services - Patients have the right to access emergency services when and where the need arises. Health plans should provide payment when a patient presents himself/herself to any emergency department with acute symptoms of sufficient severity including "severe pain" that a "prudent layperson" could reasonably expect the absence of medical attention to result in placing that consumer's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction or any bodily organ or part.
  • Being a Full Partner in HealthCare Decisions - Patients have the right to fully participate in all decisions related to their health care. Consumers 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 on medically necessary treatment options.
  • Care Without Discrimination - Patients have the right to considerate, respectful care from all members of the health care industry at all times and under all circumstances. Patients 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 have the right to communicate with health care providers in confidence and to have their individual, identifiable health care information protected in accordance with applicable privacy laws. Patients also have the right to review and copy their own medical records and request amendments to their records in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
  • The Right to Speedy Complaint Resolution - Patients 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.

Taking on New Responsibilities

In a health care system that affords patients rights and protections, patients must also take greater responsibility for maintaining good health. Patients are responsible for:

  • Providing correct and complete information about their health and past medical history
  • Reporting changes in their general health condition, symptoms or allergies to the responsible care giver
  • Reporting if they do not understand the planned treatment or their part in the plan
  • Following the recommended treatment plan they have agreed to, including instructions from nurses and other health personnel
  • Consequences that result from refusing the planned treatment
  • Keeping appointments
  • Treating others with respect
  • Paying for their care
  • Respecting the property and rights of others