Member Rights and Responsibilities

Practice preventive health care: have the tests, exams, and shots recommended for you based on your age and gender.

Rights

As a PrimeWest Health member, you have the right to:

  • Get information about the organization, its services, its practitioners and providers, and member rights and responsibilities
  • Be treated with respect, dignity, and consideration for privacy
  • Get the services you need 24 hours a day, 7 days a week. This includes emergencies.
  • Be told about your health problems
  • Get information about treatments and your treatment choices, and how they will help or harm you
  • Have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage
  • Participate with providers in making decisions about your health care
  • Refuse treatment and get information about what might happen if you refuse treatment.
  • Refuse care from specific providers
  • Know that we will keep your records private according to law
  • Request and receive a copy of your medical records. You also have the right to ask to correct the records.
  • Get notice of our decisions if we deny, reduce, or stop a service or deny payment for a service
  • File a Grievance or Appeal with us. You can also file a complaint with the Minnesota Department of Health.
  • Request a State Fair Hearing with the Minnesota Department of Human Services (also referred to as “the State”). You may request a State Fair Hearing before or at any time during our Grievance or Appeal process. You do not have to file a Grievance or Appeal with us before you request a State Fair Hearing.
  • Get a clear explanation of covered nursing home and home care services
  • Give written instructions that inform others of your wishes about your health care. This is called a “health care directive.” It allows you to name a person (agent) to decide for you if you are unable to decide or if you want someone else to decide for you.
  • Choose where you will get family planning services
  • Get a second opinion for medical, mental health, and chemical dependency services
  • Be free of restraints or seclusion used as a means of coercion, discipline, convenience, or retaliation
  • Request a copy of your Evidence of Coverage or Member Handbook at least once a year
  • Request the results of an external quality review study from the State
  • Make recommendations about our rights and responsibilities policy
  • Exercise the rights listed here
  • Get the following information from us on a yearly basis:
    • Whether we use a physician incentive plan that affects the use of referral services
    • The type(s) of incentive arrangements used
    • Whether stop-loss protection is provided
    • Results of a member survey if one is required because of our physician incentive plan

Note: There are no incentives offered to PrimeWest Health providers to give less care than your condition requires. Decisions about your health care are based only on appropriateness of care and the covered benefits you have.

For more information about PrimeWest Health’s physician incentive plan, contact our Corporate Compliance Officer at 1-888-588-4420 (toll free).

If you have any questions, concerns, problems, or suggestions, call Member Services at 1-866-431-0801 (toll free).

Responsibilities

As a PrimeWest Health member, you have the responsibility to:

  • Read your Evidence of Coverage or Member Handbook and know which services are covered under PrimeWest Health and how to get them
  • Show your PrimeWest Health membership card and your Minnesota Health Care Programs card every time you go for health care. Also, show the cards of any other health coverage you have, such as Medicare or private insurance.
  • Establish a relationship with a PrimeWest Health network primary care provider before you become ill. This helps you and your primary care provider understand your total health condition.
  • Give information asked for by your health care provider. Share information about your health history.
  • Follow all your health care provider’s instructions. If you have questions about your care, ask your health care provider.
  • Work with your health care provider to understand your total health condition. It is important to know what to do when a health problem occurs, when and where to seek help, and how to prevent health problems.
  • Never allow others to use your PrimeWest Health membership card or your Minnesota Health Care Programs card to receive services
  • Report concerns of suspected fraud immediately to PrimeWest Health

 

PW_06-15_310/H2416_PW_06-15_1009/H2926_PW_06-15_3009
CMS_Approved_07/31/2015/DHS_Approved_07/16/2015
Updated_08/03/2015