Member Rights and Responsibilities
Group Health has defined a set of rights and responsibilities for members relating to care, information, conduct, and other issues.
The Board of Trustees last updated the document outlining rights and responsibilities in June 2014.
Under "Additional Rights," learn about rights relating to information, retroactive denial of care previously authorized, participation in research, and access to new treatments.
As a Group Health consumer, you have the right to:
- Be treated with respect and dignity by all Group Health staff.
- Be assured of privacy and confidentiality regarding your health and your care.
- Have access to details about your rights and responsibilities as a patient and consumer.
- Be able to access information about Group Health, our practitioners and providers, and how to use our services.
- Receive timely access to quality care and services.
- Have access to information about the qualifications of the professionals caring for you.
- Participate in decisions regarding your health care.
- Give informed consent to receive — or to refuse — care, and be told the consequences of consent or refusal.
- Have an honest discussion with your practitioner about all your treatment options, regardless of cost or benefit coverage, presented in a manner appropriate to your medical condition and ability to understand.
- Join in decisions to receive, or not receive, life-sustaining treatment including care at the end of life.
- Create and update your advance directives and have your wishes honored.
- Have your family provide input to care decisions consistent with your advance directives or with court orders.
- Choose a personal primary care physician affiliated with your health plan.
- Expect your personal physician to provide, arrange, and/or coordinate your care.
- Change your personal physician for any reason.
- Be educated about your role in reducing medical errors and the safe delivery of care.
- Be informed of unanticipated outcomes.
- Appeal a decision and receive a response within a reasonable amount of time.
- Suggest changes to consumer rights and responsibilities and related policies.
- Receive written information in prevalent non-English language (as defined by the State).
- Receive oral interpretation services free of charge for all non-English languages, and sign or tactile interpretation services for hearing-, sight-, and speech-impairments.
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
- Protection from all forms of abuse, neglect, harassment, or discrimination.
- Have access to protective services.
- Be free from discrimination, reprisal, or any other negative action when exercising your rights.
- Request and receive a copy of your medical records, and request amendment or correction to such documents, in accordance with applicable state and federal laws.
- Voice opinions, concerns, positive comments, complaints or grievances about your care, treatment or other services without fear of retribution or denial of care and receive timely resolution of your complaint. You may also contact the following agencies:
Washington State Department of Health
HSQA Complaint Intake
P.O. Box 47857
Olympia, WA 98504-7857
Idaho Department of Health and Welfare
450 W. State St.,
Boise, ID 83702
Center for Medicare and Medicaid Services (CMS)
Office of the Medicare Beneficiary Ombudsman
1-800-MEDICARE (Medicare Help and Support)
Your responsibilities as a Group Health consumer are to:
- Provide accurate information, to the extent possible, that Group Health and your practitioner require to care for you or to make an informed coverage determination. This includes your health history and your current condition. Group Health also needs your permission to obtain needed medical and personal information. This includes your name, address, phone number, marital status, dependents’ status, and names of other insurance companies.
- Use practitioners and providers affiliated with your health plan for health care benefits and services, except where services are authorized or allowed by your health plan, or in the event of emergencies.
- Know and understand your coverage, follow plan procedures, and pay for the cost of care not covered in your contract.
- Understand your health needs and work with your personal physician to develop mutually agreed upon goals about ways to stay healthy or get well when you are sick.
- Understand and follow instructions for treatment, and understand the consequences of following or not following instructions.
- Be active, informed, and involved in your care, and ask questions when you do not understand your care or the payment for the care or what you are expected to do.
- Be considerate of other members, your health care team, and Group Health. This includes arriving on time for appointments, and notifying staff if you cannot make it on time or if you need to reschedule.
In addition to the Board-endorsed rights and responsibilities, members have specific rights related to information and care.
The right to information
Anyone who receives care at Group Health has the right to receive detailed information about:
- Availability of a point-of-service health plan
- Information referenced in your medical coverage agreement
- Access to primary and consulting-specialist care
- Descriptions of and justification for provider compensation programs
- Group Health's pharmacy, durable medical equipment (DME), and prosthetic appliance formularies
- Patient Bill of Rights
- Complaints and appeals procedures
To request information on these subjects, contact Customer Service. Medicare members may be subject to different rules because the federal government regulates their plans.
Retroactive denial of previously authorized care
We do not deny payment for care we have approved unless a member or employer group has previously canceled medical coverage.
We will give you full information about research projects that could directly involve you. We may ask if you are willing to take part in research projects, but you are free to refuse for any reason. Refusal will not affect your health care. If treatments are being tested, we may give them only to those in the research studies.
Access to new treatments
Generally, we try to avoid widespread use of experimental, unproven preventive methods of treatment. We require that a new test or treatment has a body of scientific evidence establishing its effectiveness before encouraging our patients and doctors to use it. Our medical, legal, administrative, and coverage departments and by a team of Group Health members review such treatments.
Additionally, we strongly encourage care providers to discuss all care options with their patients. This way you can be assured that you will always receive the appropriate care and service.
For important information about our health plans and health information practices, please review our disclosure statement (PDF).