UPMC Health Plan (Commercial Members)

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Rights of Members
Responsibilities of Members

Rights of Members

To receive information about the Health Plan, its services, its programs, its health care providers, and your rights and responsibilities
To be treated with respect and recognition of your dignity and right to privacy
To participate with health care providers in decision-making regarding your health care
To receive clear and complete information from your health care provider about your health condition and treatment
To participate in a candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage
To voice complaints, grievances, or appeals about the Health Plan, the care provided, or your health care provider
To choose your own health care provider from the list of network providers and to receive timely care in an emergency
To see your medical records, to keep copies for yourself, and to ask to have corrections made, if needed
To have your medical information kept confidential whether it is in written, oral, or electronic format
To make decisions about your treatment, including the right not to participate in research, and to refuse treatment as long as you understand that by refusing you may cause your health problem to get worse or possibly become fatal
To execute a living will and/or a durable power of attorney that tells how decisions about your treatment will be made if you are unable to make decisions for yourself
To be represented by parents, guardians, family members, or other conservators if unable to fully participate in your treatment decisions
To make recommendations regarding the Health Plan's members' rights and responsibilities policy
To access, amend, restrict, request alternate communication (method or location), and receive an accounting of any disclosures of personal health information made to persons or organizations other than yourself, and for purposes other than treatment, payment, and operation

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Responsibilities of Members

To provide, to the extent possible, information that the Health Plan and its health care providers need in order to care for you
To follow plans and instructions for care that you have agreed on with your health care providers
To treat your health care provider and other health care workers with dignity and respect, which includes being on time for appointments and calling ahead if you need to cancel an appointment
To tell your health care provider as much about your medical history as you know
To follow your health care provider's directions, such as taking the right amount of medication at the right times if you agreed to do so
To ask questions about how to access health care services appropriately
To participate, to the extent possible, in understanding any health or behavioral health problems you may have and developing mutually agreed upon treatment goals
To provide a safe environment for services rendered in your place of residence
To pay applicable copayments, coinsurance, deductibles, and fees

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