Atlantis Health Plan Member Handbook- POS
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MEMBER RIGHTS & RESPONSIBILITIES:
As an Atlantis Health Plan Member, you have the following RIGHTS AND RESPONSIBILITIES:
As a Member or Prospective Member, you also have the RIGHT to request AHP to provide:
- To obtain complete, current information concerning a diagnosis, treatment and prognosis from a physician or other provider in terms that you can be reasonably expected to understand. When it is not advisable to give such information to the Member, the information will be made available to an appropriate person on the Member's behalf;
- To receive information from a physician or other provider necessary to give informed consent prior to the start of any procedure or treatment; and to refuse treatment to the extent permitted by law and to be informed of the medical consequences of that action.
- To participate in decisions relating to your health care. Working with your doctor, you can decide whether to accept or reject proposed medical treatments. That right extends to situations where, because of your medical condition, you are unable to communicate with your doctor or the hospital. This is done by the creation of an Advance Directive.
- A list of the names, business addresses and official positions of the board of directors, controlling persons, owners or partners of the health maintenance organization;
- A copy of the most recent annual AHP certified financial statement, including a balance sheet and summary of receipts and disbursements prepared by a certified public accountant;
- A copy of the most recent individual, direct pay subscriber contracts;
- Information relating to consumer complaints compiled pursuant to section two hundred of the insurance law;
- AHP procedures for protecting the confidentiality of medical records and other Member information;
- To inspect drug formularies, if used by AHP, and obtain information on whether individual drugs are included or excluded from coverage;
- A written description of the quality assurance procedures used by AHP;
- A description of the procedures followed by AHP in making decisions about the experimental or investigational nature of individual drugs, medical devices or treatments in clinical trials;
- A list of individual health practitioner affiliations with participating hospitals, if any;
- Specific written clinical review criteria relating to a particular condition or disease and, where appropriate, other clinical information which AHP might consider in our utilization review, along with how it will be used in the utilization review process, provided, however, that the information is only used by you in evaluating the covered services provided by AHP;
- A copy of the application procedures and minimum qualification requirements for health care providers to be considered by AHP; and
- Other information as required by the New York State Insurance Commissioner, provided that such requirements are promulgated pursuant to the state administrative procedure act.
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