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Member Rights & Responsibilities

All Wellmark members are encouraged to know their rights and responsibilities. Informed members have greater control over their health care decisions and well-being.

 

 

Your Rights

  • You have the right to receive accurate information about your health plan, its services, its network of providers, and your rights and responsibilities.
     
  • You have the right to receive accurate information on utilization management notification requirements and case management services.
     
  • You have the right to be treated with respect, in a manner that preserves your dignity and recognizes your right to privacy.
     
  • You have the right to participate fully, with your providers, in decision-making that affects your health care.
     
  • You have the right to expect a candid discussion of all appropriate or medically necessary treatment options pertaining to your condition, regardless of cost or benefit coverage.
     
  • You have the right to voice complaints or appeals about your health plan or the care delivered by any of its providers.
     
  • You have the right to make recommendations regarding our members' rights and responsibilities policy.

Your Responsibilities

 

Likewise, you share responsibility for maintaining your own good health.

  • You have the responsibility to provide, to the extent possible, information that the health plan needs to process claims and information your providers need to provide care for you.
     
  • You have the responsibility to participate in understanding your health problems and participate in developing mutually agreed upon treatment goals to the degree possible.
     
  • You have the responsibility to follow the plans and instructions for care that you have agreed to with your providers.
     
  • You have the responsibility to present your ID card prior to receiving services.


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