Member Rights and Responsibilities

Your Rights

As a member of Highmark Health Options, you have rights around your health care. 

You have the right to:

  • Ask for and obtain all included information.
  • Be told about your rights and responsibilities.
  • Get information about Highmark Health Options, our services, our providers, and your rights.
  • Be treated with respect and dignity.
  • Not be discriminated against by Highmark Health Options.
  • Access all services that Highmark Health Options must provide.
  • Choose a provider in our network.
  • Take part in decisions about your health care.
  • Refuse treatment and choose a different provider.
  • Get information on treatment options and different courses of care.
  • Have your privacy respected.
  • Ask for and get your medical records.
  • Ask that your medical records be changed or corrected if needed.
  • Be sure your medical records will be kept private.
  • Recommend changes in policies and procedures.
  • Be free from any form of restraint or seclusion used as a means of force, discipline, convenience, or retaliation.
  • Get covered services, no matter your cultural or ethnic background or how well you understand English.
  • Get covered services regardless of if you have a physical or mental disability, or if you are homeless.
  • Refer yourself to in-network and out-of-network family planning providers.
  • Access certified nurse midwife services and certified pediatric or family nurse practitioner services.
  • Get emergency post-stabilization services.
  • Get emergency health care services at any hospital or other setting.
  • Accept or refuse medical or surgical treatment and to make an advance directive.
  • Have your parent or a representative make treatment decisions when you can’t.
  • Make complaints and appeals.
  • Get a quick response to problems raised around complaints, grievances, appeals, authorization, coverage, and payment of services.
  • Ask for a state fair hearing after a decision has been made about your appeal.
  • Request and get a copy of your Member Handbook.
  • Disenroll from your health plan.

Your Responsibilities

As a member of Highmark Health Options, you also have some responsibilities:

  • Read through and follow the instructions in your Member Handbook.
  • Work with your PCP to manage and improve your health.
  • Ask your PCP any questions you may have.
  • Call your PCP at any time when you need health care.
  • Give information about your health to Highmark Health Options and your PCP.
  • Always remember to carry your member ID card.
  • Only use the ER for true emergencies.
  • Keep your appointments.
  • If you must cancel an appointment, call your PCP as soon as you can to let him or her know.
  • Follow your PCP’s recommendations about appointments and medicine.
  • Go back to your PCP or ask for a second opinion if you do not get better.
  • Call Member Services at 1-833-957-0020 (TTY: 711) whenever anything is unclear to you or you have questions.
  • Treat health care staff and others with respect.