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Member Rights and Responsibilities

Your rights are what you can expect from SmartHealth……

As a SmartHealth medical-enrolled member, you have the right to:

• Receive information about SmartHealth, covered services, participating physicians and facilities and your rights and responsibilities.
• Understand the services SmartHealth provides.
• Make recommendations regarding the SmartHealth Member Rights and Responsibility policy
• Receive courteous, timely, accessible, and quality health care.
• Be treated with dignity, respect and privacy.
• Expect that your records will remain private and confidential.
• Get information about how we pay our providers.
• Know and understand your diagnosis and treatment options.
• Be involved with your provider in making decisions about your treatment.
• Have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
• Expect that SmartHealth will fully investigate the substance of a complaint or grievance in a timely manner.
  

Your responsibilities are what SmartHealth expects from you……

As a SmartHealth Member, you have the responsibility to:

• Inform your physicians, practitioners and SmartHealth (to the extent possible) of any information needed to provide you with care.
• Use only SmartHealth participating physicians and health care facilities.
• 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 plan you have agreed on with your provider.
• Be on time for appointments and call the physician right away if you must cancel.
• Carry your SmartHealth member ID card and present it when you receive care.
• Seek care from an emergency room only in the event of a life-threatening emergency.
• Call your primary care physician within 48 hours of receiving emergency care so that he or she can arrange your follow-up care.
• Pay any co-payment when you receive care.
• Tell us if you move, change your address, or add or drop a family member under your benefits.
• Follow all SmartHealth procedures.
• Pay for services that are not covered by SmartHealth if you seek or receive these services.
• Request that SmartHealth review and approve all services that must be authorized in advance.
• Pay for covered services when you choose to obtain services and do not follow SmartHealth rules that require that you request and receive approval in advance.
• Keep your health care benefits and coverage changes current.
• Call Worklife Services if you have questions.