Member Rights and Responsibilities

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
  • 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
  • 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 and PrimeWest Health's Notice of Privacy Practices
  • File a Grievance or Appeal with us. You can also file a complaint with the Minnesota Department of Health (MDH).
  • Request a State Appeal (State Fair Hearing) with the Minnesota Department of Human Services (DHS) (also referred to as “the State”). You must Appeal to us before you request a State Appeal (State Fair Hearing). If we take more than 30 days to decide your plan Appeal and we have not asked for an extension, you do not need to wait for our decision to ask for a State Appeal (State Fair Hearing).
  • 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
  • Participate with providers in making decisions about your health care
  • Be treated with respect, dignity, and consideration for privacy
  • 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.
  • Be free of restraints or seclusion used as a means of coercion, discipline, convenience, or retaliation
  • Choose where you will get family planning services, diagnosis of infertility, sexually transmitted disease testing and treatment services, and AIDS and HIV testing services
  • Get a second opinion for medical, mental health, and substance use disorder services
  • Request a copy of your Evidence of Coverage (EOC) or Member Handbook at least once a year
  • Have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage
  • Get a clear explanation of covered nursing home and home care services
  • Get the following information from us, if you ask for it. Call Member Services at 1-866-431-0801 (toll free). TTY users call 1-800-627-3529 or 711 (toll free).
    • Whether we use a physician incentive plan that affects the use of referral services and details about the plan if we use one
    • Results of an external quality review study from the State
    • The professional qualifications of health care providers
  • Make recommendations about our rights and responsibilities policy
  • Exercise the rights listed here

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). TTY users call 1-800-627-3529 or 711 (toll free).

If you have any questions, concerns, problems, or suggestions, call Member Services at 1-866-431-0801 (toll free). TTY users call 1-800-627-3529 or 711 (toll free).

Responsibilities

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

  • Read your Evidence of Coverage (EOC) or Member Handbook and know which services are covered under PrimeWest Health and how to get them
  • Show your PrimeWest Health member ID 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 qualified health care provider and/or health plan so the right care or services can be provided to you. Share information about your health history.
  • Work with your qualified health care provider to understand your total health condition. Develop mutually agreed-upon treatment goals when possible. If you have questions about your care, ask your qualified health care provider.
  • Know what to do when a health problem occurs, when and where to seek help, and how to prevent health problems
  • Practice preventive health care. Have tests, exams, and shots recommended for you based on your age and gender.
  • Never allow others to use your PrimeWest Health member ID card or your Minnesota Health Care Programs card to receive services
  • Report concerns of suspected fraud immediately to PrimeWest Health

 

PW_08-17_348R_03-18/DHS_Approved_04/04/2018
H2416_PW_08-17_1027R_03-18/CMS_Approved_05/01/2018/DHS_Approved_05/01/2018
H2926_PW_08-17_3027R_03-18/CMS_Approved_04/20/2018/DHS_Approved_04/04/2018
Updated_05/01/2018