Member Rights and Responsibilities
Prospect Medical recognizes the following rights for its members:
- To receive information about Prospect Medical, its services, its providers, and members’ rights and responsibilities
- To be treated with respect and dignity and right to privacy
- To make recommendations regarding the organization’s members’ rights and responsibilities policies
- To participate with practitioners in decision-making regarding their healthcare
- To have a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit
- To voice complaints or file appeals regarding Prospect Medical or the care provided
- To be represented by parents, guardians, family members or other conservators for those who are unable to fully participate in their treatment decisions
- To have their medical information kept confidential
- To receive oral interpretation services in an understandable language (Medicaid and/or Medicare members)
- To receive written member information in large-size print and other formats upon request and in a timely manner appropriate for the format being requested (Medicaid and/or Medicare members)
- To work with Prospect Medical to coordinate interpreter services, at no cost to the member, for members’ who require language or speech/hearing impaired services.
- Prospect Medical does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.
- Members have the right to file a discrimination complaint with the United States Department of Health and Human Services Office of Civil Rights if there is a concern of discrimination based on race, color, national origin, age, disability, or sex electronically through the Office for Civil Rights Complaint Portal or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201. Complaint forms are available at the U.S. Department of Health and Human Services website. Complaints filed with the U.S. Department of Health and Human Services, Office for Civil Rights must be filed within 180 days of the date of the alleged discrimination.
- To have confidential medical treatment for sensitive services and to request that communications regarding those services be sent to an alternative address.
Prospect Medical members must accept the following responsibilities:
- To understand their health problems and participate in developing mutually agreed-upon treatment goals to the degree possible
- To follow plans and instructions for care that they have agreed on with their practitioners
- To supply all pertinent information about their health (to the extent possible)
- To learn about their medical condition and what keeps them healthy
- To make and keep medical appointments. If a member must cancel and/or reschedule an appointment, be certain to tell someone in the office
- To work with and be polite and respectful to those who are partners in their healthcare
Affirmative Statement Regarding Incentives
Utilization Management Affirmative Statement Regarding Incentives will be signed by all UM decision makers yearly. Prospect Medical does not give financial incentives for UM decision makers and does not encourage denials of coverage or services. Decision makers include Medical Directors, UM and CM Managers, Case Management, Quality Improvement Committee members, licensed staff and management personnel.
Providers may freely communicate with patients about their treatment, regardless of benefit coverage limitations.
