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Statement of Member Rights
PHCS is committed to treating members in a manner that respects their rights. Below
is our statement recognizing member rights and protections. We expect our Network
providers, including individual practitioners, to support and act in accordance with
these rights.
- Members have the right to receive accurate, easily understood information about
PHCS, the services we provide, the providers in our Network, the rights of
members and PHCS Network providers, and how to contact us regarding
concerns about PHCS services or Networks.
- Members have the right to be treated with respect and recognition of their
dignity and the right to privacy. This right includes protecting the
confidentiality of medical and other personal information. It also includes
members' rights to review their medical and personal information on file at
PHCS, as required by applicable state and federal law.
- Members have the right to participate with providers in making decisions about
their health care. This includes the right to have candid discussions of
appropriate or medically necessary treatment options for their health conditions,
without regard to cost or benefit coverage.
- Members have the right to register complaints or appeals about PHCS, our services,
determinations, or the care provided by a PHCS Network provider.
This includes the right to have complaints or appeals addressed in a timely manner
through formal procedures appropriate to the nature of the complaint or appeal.
- Members have the right to timely and appropriate decision-making regarding the
delivery of health care services, consistent with the terms of their health
benefit plans and applicable state and federal law.
- Members have the right to a choice of health care providers from the PHCS
Network, consistent with the terms of their health benefit plans and
applicable state and federal law.
- Members have the right, without regard to benefit coverage, to access emergency
health care services in the event they believe that their condition, illness or
injury is of such a nature that failure to obtain immediate medical care could
place their life or health in serious jeopardy.
- Members have the right to receive health care services without discrimination.
PHCS Network providers are precluded by contract from differentiating
or discriminating against members in the provision of health care services due to
certain member characteristics, and are required to render such services to all
members in the same manner, in accordance with the same standards, and with the
same availability as offered to the Network provider's other patients.
PHCS uses its best efforts to assure that all members are afforded these rights. If
you feel that your rights as a member have not been met, you may voice your concern
through the PHCS complaint resolution process. The complaint resolution process is
the formal mechanism by which PHCS addresses members' concerns about their health
care from our Network providers. To begin the complaint resolution process, document
the complaint in writing and send it to:
Private Healthcare Systems
1100 Winter Street
Waltham, MA 02451-1227
Attn: Corporate Quality Management
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