Member Rights & Responsibilities

Your rights are what you can expect from Preferred Choices PPO

As a Preferred Choices PPO member, you have the right to:

• Receive courteous, timely, accessible, and quality health care by self-referring to physicians and providers who participate in Preferred Choices PPO network.
• Be treated with dignity and respect.
• Understand the services we provide through our network of participating providers.
• Receive information about our current list of participating physicians and hospitals.
• Know and understand your diagnosis and treatment options.
• Know that Preferred Choices PPO only discounts claims and forwards them to your benefit administrator or insurance carrier. Any claim appeals should be directed to your benefits administrator.
• Be involved in decisions about your treatment, including the right to refuse treatment.
• Express complaints about the provider network through the Preferred Choices PPO Customer Service department.
• Expect that Preferred Choices PPO will fully investigate the substance of a complaint about a participating provider in a timely manner and allow you to appeal the decision.
• Expect that your medical records will remain private and confidential.

Your responsibilities are what Preferred Choices PPO expects from you

As a Preferred Choices PPO member, you have the responsibility to:

• Inform your physicians and/or practitioners (to the extent possible) any information needed to provide you with care
• Understand your health needs and participate mutually with your provider to develop your treatment goals (to the degree possible).
• Follow your provider’s instructions for the care you have agreed on with your provider.
• Be on time for appointments and call the physician right away if you must cancel.
• Carry your member ID card and present it when you receive care in order to receive the in-network participating provider discount.
• Call your physician within 48 hours of receiving emergency care so that he or she can arrange your follow-up care.
• Tell your physician and employer if you are covered by other health care coverage.
• Tell your employer if you move, change your address, or add or drop a family member under your benefits.
• Call Customer Service if you have any questions.
• Keep your health care benefits and coverage changes current.