HMO Members: Know Your Member Rights and Responsibilities

HMO Members: Know Your Member Rights and Responsibilities

This article is intended for HMO members enrolled in an employer health insurance plan.

Below is a list of your member rights and responsibilities. Please be sure to keep this information as a reference.

As a member of BlueLincs HMOSM, you have the right to:
  • Get information about BlueLincs, its services and providers and members’ rights and responsibilities.
  • Have all medically necessary care covered under your benefit package by your BlueLincs provider.
  • Receive thoughtful and polite care with respect for personal privacy.
  • Receive your diagnosis, treatment choices and outlook in clear, understandable language.
  • Be involved in decision-making about your treatment.
  • Have a direct conversation about appropriate or medically necessary treatment choices for your conditions, no matter the cost or benefit coverage.
  • Have confidentiality of information about your treatment.
  • Know the identity of all people involved in your care.
  • Refuse treatment and to be told of the medical consequences.
  • Be told of research projects involving your care and the right to refuse participation in them.
  • File a complaint or grievance and be given due process.
  • Appeal an Adverse Benefit Determination or a decision regarding a preauthorization request, if you feel it is in error.
  • Name an authorized representative to act on your behalf in pursuing a benefit claim or appeal of an Adverse Benefit Determination.
As a member of BlueLincs HMO, it is your responsibility to:
  • Work with your primary care physician (PCP) in maintaining a satisfactory physician-patient relationship.
  • Get in touch with your PCP for authorization of care when you choose to use your benefits.
  • Follow the prescribed medical treatment.
  • Give complete health status information for accurate diagnosis and appropriate treatment.
  • Keep appointments for care and give needed cancellation notice.
  • Read and understand all materials about your health benefits.
  • Tell your employer and BlueLincs of any other group coverage you have and assist BlueLincs in its coordination of benefits efforts.
  • Pay any required part of your premium and the copayment amounts required under your benefits coverage.
  • Call BlueLincs at 800-580-6202 when you are unsure of procedures or covered benefits.

If you have questions about your coverage, please call the toll-free customer service phone number on your member ID card.

Originally published 3/6/2020; Reviewed 2022