Member Rights and Responsibilities
The Member Rights and Responsibilities Statement is published each year in the Evidence of Coverage (EOC). It is available on our website at mypreferredcare.com or by contacting the Network Management Department at 877- 670-8432.
If our member has questions about their rights, please refer them to the Member Services phone number on the back of their ID card.
Member Participation in Treatment Options
Members have the right to freely communicate with their physician and participate in the decision-making process regarding their health care, regardless of their benefit coverage. Each member has the right to receive information on available treatment options (including the option of no treatment) or alternative courses of care and other information specified by law, as applicable.
Competent members have the right to refuse recommended treatment, counsel or procedure. The health care professional may regard such refusal as incompatible with the continuance of the care provider/patient relationship and the provision of proper medical care. If this occurs, and the health care professional believes that no professionally acceptable alternatives exist, they must so inform the member in writing, by certified mail.
The healthcare professional must give the member 30 calendar days to find another care provider. During this time, the health care professional is responsible for providing continuity of care to the member.
The federal Patient Self-Determination Act (PSDA) of 1990 gives individuals age 18 and older the legal right to make choices about their medical care in advance of incapacitating illness or injury through an advance directive.
This law states that members’ rights and personal wishes must be respected, even when the member is too sick to make decisions on their own. You may find the Patient Self- Determination Act at gpo.gov.
To help ensure a person’s choices about health care are respected, the Florida legislature enacted Chapter 765, Florida Statutes. It requires all care providers and facilities to provide their patients with written information regarding treatment options.
Document this discussion at least once in the member’s record.
To comply with this requirement, we also inform members of state laws on advance directives through our members’ benefit material. We encourage you to have these discussions with our members.
Online Resources: You may find the federal Patient Self- Determination Act at gpo.gov. You may download free forms from the state at floridahealthfinder.gov/reportsguides/ advance-directives.aspx.
Information is also available from the Robert Wood Foundation, Five Wishes. The information there meets the legal requirements for an advance directive in Florida and may be helpful to members. Five Wishes is available on AgingWithDignity.org.
Member Financial Responsibility
Members are responsible for the copayments, deductibles and coinsurance associated with their benefit plan. ollect copayments at the time of service. To determine the exact member responsibility related to benefit plan deductibles and coinsurance, we recommend you submit claims first. You will then receive the Summary of Benefits (SOB) to see what the patient needs to pay.
If you prefer to collect payment at the time of service, you must make a good faith effort to estimate the member’s responsibility using our Claims & Payment tool.