General Insurance FAQ
Patient Rights FAQ
You have the right to:
- Receive all the benefits to which you are entitled under your contract;
- Receive quality health care through your providers in a timely manner and medically appropriate setting;
- Considerate, courteous and respectful care;
- Be treated with respect and recognition of your dignity and right to privacy.
- Information about services, staff, hours of operation and your benefits, including access to routine services as well as after-hours and emergency services, and members’ rights and responsibilities;
- Participate in decision-making with your physician about your health care;
- Obtain complete, current information concerning a diagnosis, treatment and prognosis from a provider in terms that you can reasonably be expected to understand;
- Refuse treatment as allowed by law, and be informed by your physician of the medical consequences;
- Refuse to participate in research;
- Confidentiality of medical records and information, with the authority to approve or refuse the re-disclosure by us of such information, to the extent protected by law;
- Receive all information needed to give informed consent for any procedure or treatment;
- Access to your medical records as permitted by New York State law;
- Express concerns and complaints about the care and services provided by physicians and other providers, and have us investigate and respond to these concerns and complaints;
- Candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage;
- Care and treatment without regard to age, race, color, sex or sexual orientation, religion, marital status, national origin, economic status or source of payment;
- Voice complaints or appeals and recommend changes in benefits and services to staff, administration and/or the New York State Insurance Department or Department of Health, without fear of reprisal;
- Formulate advance directives regarding your care. To obtain a Health Care Proxy form, contact us;
- Contact one of our service departments to obtain the names, qualifications and titles of providers who are responsible for your care;
- All information about your health plan, its services and its providers and procedures.
- To make recommendations regarding the organization’s members’ rights and responsibilities.
Protect Your Privacy
Who besides me can gain access to my claims, benefits and other Protected Health Information (PHI)?
Under the federal Health Insurance Portability and Accountability Act (known by its acronym, HIPAA), we are required to protect any and all information that could lead anyone to identify you by your past, present and/or future medical or mental health treatment or conditions. This is also known as your protected health information (PHI).
Because of HIPAA, we cannot release any information regarding your policy, claims or benefits without your express permission.
The law does allow us to discuss your PHI with your health care providers, but only within the scope of services that they themselves are providing to you.
Will the privacy laws prohibit me from getting member-specific information for my dependent who is over 18, my elderly parents or even my spouse’s claims if I’m also on the policy?
Yes, these regulations require that any protected health information about members or their dependents age 18 or older cannot be released, even to family members, without the member’s authorization.
If my life or my dependent’s life is in jeopardy, are you allowed by law to give PHI to anyone else?
If not releasing the information would put your health in danger, we are allowed to release it to those who need to know it. In these cases, we will not release more information than necessary.
How do I select a PCP?
Our Find A Doctor online tool is designed to help you connect with any doctor participating in our network, including Primary Care Physicians.
If you would rather speak to us directly, please contact our Customer Service department at the number listed on the back of your Member card
How do I change a PCP?
If you are currently in treatment with your PCP, we can make the change effective on the date of your request.
For our records, we may ask that you give a reason for changing your PCP. This information is optional and can be used to track patient access, quality of care and other provider trends. Follow this link to Select or Change Your Doctor Now. If you would rather speak to us directly, please contact our Customer Service department at the number listed on the back of your Member card.
Do I need to get a referral from my PCP before I obtain services from other providers or facilities?
You may or may not need a referral from your PCP in order to obtain services from a specialist or other provider. Check your contract or benefit booklet, talk to your employer group representative or contact us if you are unsure whether or not you need to obtain a referral from your PCP.