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Do Your Patients Understand Their Rights and Responsibilities?

Date: 05/06/24

Superior HealthPlan encourages providers to participate in helping members understand their Rights and Responsibilities. This is extremely important as you/your staff interact with members, caregivers and consenters from various cultural and linguistic backgrounds. To ensure a positive member experience with each encounter, providers should follow these four steps when working with members:

  1. Understand Provider Rights and Responsibilities and how they impact members.
  2. Review Member Rights and Responsibilities to gain a comprehensive understanding.
  3. Participate in educating and providing clarity to members about their Rights and Responsibilities.
  4. Advocate for members as they navigate through processes/procedures in their Rights and Responsibilities, if applicable (ex: appeal process).

Members are provided their Rights and Responsibilities annually or upon request. The Member Rights and Responsibilities help bridge the gap between the provider’s responsibility to deliver quality care and the member’s understanding of their choices when seeking care. Superior’s Member Rights and Responsibilities include, but are not limited to:

Member Rights

  • A right to receive information about Superior, our services, practitioners, and providers.
  • Assurance that members are treated with respect and dignity and that private health information and communications regarding their health are kept confidential.
  • Have a candid discussion of appropriate or medically necessary treatment options, regardless of cost of benefit coverage.
  • Availability of a complaint and appeal process through Superior and/or Medicaid.
  • Timely access to care that does not have communication or physical access barriers.
  • The opportunity to actively participate in treatment decisions and ability to refuse treatment.
  • Ability to make recommendations regarding Superior’s Member Rights and Responsibilities policy.

Member Responsibilities

  • Learning and understanding their Member Rights.
  • Abiding by Superior’s policies and procedures.
  • Sharing health information and learning about treatment and service options.
  • Understanding their health problems and following plans and instructions for care that they have agreed to with their practitioners.
  • Keeping their scheduled doctor appointments.

The full list is accessible on Superior’s Member Rights and Responsibilities webpage. If a member inquires about obtaining their Rights and Responsibilities, they can contact Member Services at the phone number listed on the back of their Member ID card for assistance.

In compliance with privacy regulations, Superior provides members with a privacy notice and assures members that private health information and communications regarding their health are kept confidential. The notice describes how Superior can use or share a member’s health records and how the member can get access to the information. In addition, the member privacy notice informs the member of their health-care privacy rights and explains how these rights can be exercised. Full details about these practices are listed on Superior’s Notice of Privacy Practices webpage.

Please note: Providers may review the Provider Rights and Responsibilities in the provider manuals found on Superior’s Training and Manuals webpage. Providers may also access Superior’s Member Rights and Responsibilities webpage for additional information.

With your help, we can continue to ensure all members understand their health-care Rights and Responsibilities.