As a member of the plan, you have the right to:
- Available and accessible services for Medically Necessary and Covered Services, including 24 hours per day, 7 days per week for Urgent or Emergency Services, and for other Health Care Services as defined by your Policy or Summary of Benefits and Coverage.
- Be treated in a prompt, courteous and responsible manner that respects your dignity and privacy.
- Affordable health care including information regarding your out-of-pocket expenses; limitations; the right to seek care from a non-participating provider; and an explanation of your financial responsibility when services are provided by a non-participating provider or without Prior Authorization.
- Choose a Primary Care Provider within the limits of the Covered Services, the Plan’s network and, as provided by the Policy, including the right to refuse care of specific health care professionals.
- Be promptly notified of termination or changes in benefits, services or the Provider Network.
- Confidential handling of all communications, including medical and financial information, maintained by the Plan. CHRISTUS Health Plan and our providers will maintain privacy of your medical and financial records in accordance with existing law.
- A complete explanation of why a benefit is denied, the opportunity to appeal the denial decision to our internal review and the right to request help from the Superintendent.
- Know, upon request, of any financial arrangements or provisions between the Plan and our participating providers, which may restrict referrals or treatment options or limit the services offered to you.
- Qualified health care professionals for treatment and services that are Covered Benefits near where you live or work within the Plan’s service area.
For a full list of Member Rights, please refer to your plan’s Evidence of Coverage.