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.