Subscriber bill of rights

As a Blue Shield PPO plan subscriber, you have the right to:

  1. Receive considerate and courteous care, with respect for your right to personal privacy and dignity.
  2. Receive information about all health services available to you, including a clear explanation of how to obtain them.
  3. Receive information about your rights and responsibilities.
  4. Receive information about your PPO health plan, the services we offer you, the physicians and other practitioners available to care for you.
  5. Have reasonable access to appropriate medical services.
  6. Participate actively with your physician in decisions regarding your medical care. To the extent permitted by law, you also have the right to refuse treatment.
  7. A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage.
  8. Receive from your physician an understanding of your medical condition and any proposed appropriate or medically necessary treatment alternatives, including available success/outcomes information, regardless of cost or benefit coverage, so you can make an informed decision before you receive treatment.
  9. Receive preventive health services.
  10. Know and understand your medical condition, treatment plan, expected outcome, and the effects these have on your daily living.
  11. Have confidential health records, except when disclosure is required by law or permitted in writing by you. With adequate notice, you have the right to review your medical record with your Physician.
  12. Communicate with and receive information from Customer Service in a language you can understand.
  13. Know about any transfer to another hospital, including information as to why the transfer is necessary and any alternatives available.
  14. Be fully informed about the Blue Shield grievance procedure and understand how to use it without fear of interruption of health care.
  15. Voice complaints or grievances about the PPO health plan or the care provided to you.
  16. Participate in establishing public policy of the Blue Shield PPO, as outlined in your Evidence of Coverage or Health Service Agreement.
  17. Make recommendations regarding Blue Shield’s member rights and responsibilities policy.

Subscriber responsibilities

As a Blue Shield PPO Plan Subscriber, you have the responsibility to:

  1. Carefully read all Blue Shield PPO materials immediately after you are enrolled so you understand how to use your benefits and how to minimize your out of pocket costs. Ask questions when necessary. You have the responsibility to follow the provisions of your Blue Shield PPO membership as explained in the Evidence of Coverage or Health Service Agreement.
  2. Maintain your good health and prevent illness by making positive health choices and seeking appropriate care when it is needed.
  3. Provide, to the extent possible, information that your physician, and/or the plan need to provide appropriate care for you.
  4. Understand your health problems and take an active role in developing treatment goals with your medical care provider, whenever possible.
  5. Follow the treatment plans and instructions you and your physician have agreed to and consider the potential consequences if you refuse to comply with treatment plans or recommendations.
  6. Ask questions about your medical condition and make certain that you understand the explanations and instructions you are given.
  7. Make and keep medical appointments and inform your physician ahead of time when you must cancel.
  8. Communicate openly with the physician you choose so you can develop a strong partnership based on trust and cooperation.
  9. Offer suggestions to improve the Blue Shield PPO plan.
  10. Help Blue Shield to maintain accurate and current medical records by providing timely information regarding changes in address, family status and other health plan coverage.
  11. Notify Blue Shield as soon as possible if you are billed inappropriately or if you have any complaints.
  12. Treat all plan personnel respectfully and courteously as partners in good health care.
  13. Pay your dues, copayments and charges for non-covered services on time.
  14. For all mental health services, follow the treatment plans and instructions agreed to by you and the Mental Health Service Administrator (MHSA) and obtain prior authorization for all non-emergency inpatient mental health services.
  15. Follow the provisions of the Blue Shield Benefits Management Program.