会员权利与责任

365betway下载 ❯ 回 bat365官方下载 ❯ 会员权利与责任

As a Blue Cross and Blue Shield of North Carolina (蓝十字数控) member, 你有一定的权利和责任.

你的权利

As a 蓝十字数控 member, you have the right to:

  • 收到 information about your coverage and your rights and responsibilities as a member.
  • 收到, 要求, 关于你计划的事实, including a list of doctors and health care services covered.
  • 收到 polite service and respect from 蓝十字数控.
  • 收到 polite service and respect from the doctors who are part of the 蓝十字数控 networks.
  • 收到 the reasons why 蓝十字数控 denied a request for 治疗 or health care service, 而这些规则是用来达到这些结果的.
  • 收到, 要求, details on the rules used by 蓝十字数控 to decide whether a procedure, 治疗, 网站, 设备, 药物或设备需要事先批准.
  • 收到, 要求, a copy of 蓝十字数控's list of covered prescription drugs. You can also request updates about when a drug may become covered.
  • 收到 clear and correct facts to help you make your own health care choices.
  • 积极参与你的365betway下载保健 and discuss 治疗 options with your doctor without regard to cost or benefit coverage.
  • Participate with practitioners in making decisions about your health care.
  • Expect that 蓝十字数控 will take measures to keep your health information private and protect your health care records.
  • Voice complaints and expect a fair and quick appeals process for addressing any concerns you may have with 蓝十字数控.
  • Make recommendations regarding 蓝十字数控's member rights and responsibilities policies.
  • 接收关于蓝十字NC的信息, 它的服务, its practitioners and providers and members' rights and responsibilities.
  • Be treated with respect and recognition of your dignity and right to privacy.

你的责任

作为蓝十字NC的bat365官方下载，你应该:

  • Present your 蓝十字数控 ID card each time you receive a service.
  • Read your 蓝十字数控 benefit booklet and all other 蓝十字数控 member materials.
  • Call 蓝十字数控 when you have a question or if the material given to you by 蓝十字数控 is not clear.
  • Follow the course of 治疗 prescribed by your doctor. If you choose not to comply, advise your doctor.
  • Provide 蓝十字数控 and your doctors with complete information about your illness, 事故或365betway下载问题, 提供护理可能需要哪些因素.
  • Understand your health problems and participate in developing mutually agreed-upon 治疗 goals to the degree possible.
  • Make appointments for non-emergency medical care and keep your appointments. If it is necessary to cancel an appointment, give the doctor's office at least 24-hours notice.
  • 积极参与你的365betway下载保健.
  • Be polite to network doctors, their staff and 蓝十字数控 staff.
  • Tell your place of work and 蓝十字数控 if you have any other group coverage.
  • Tell your place of work about new children under your care or other family changes as soon as you can.
  • Protect your 蓝十字数控 ID card from improper use.
  • Comply with the rules outlined in your member benefit guide.
  • 1

    In the event of any inconsistency between information contained in this summary and the member's Benefit Booklet, 以福利小册子为准.

  • 2

    The Benefit Booklet defines an adverse benefit determination as follows: A denial, 减少或终止, or failure to provide full or partial payment for, 一个好处, including one that results from the application of any utilization review, or a failure to cover an item or service for which benefits are otherwise provided because it is determined to be experimental or investigational or not medically necessary or appropriate. Rescission of coverage is also included as an adverse benefit determination. The National Committee for Quality Assurance (NCQA) is an independent, not-for-profit organization that evaluates and reports on the quality of the nation's managed care plans. NCQA maintains and regularly updates quality standards utilized by the health insurance industry to gauge levels of ongoing quality and improvement. The NCQA accreditation program helps employers and consumers compare health plans based on various quality measures.

     

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