Utilization Management Consumer Rights and Responsibilities:
Consumer Rights:To be treated with dignity and respect.
To receive complete information about the diagnosis, proposed course of treatment or procedure, alternate courses of treatment or non-treatment, the clinical risks involved in each and prospects for recovery in terms that are understandable to the consumer, in order to give informed consent or to refuse that course of treatment.
To every consideration of privacy and to expect that all communications and records related to his/her care will be treated as confidential.
To be given access to the utilization management department for timely responses to questions and requests made for service.
To be given information on how to file a complaint.
To be informed of utilization management policies including how to file an appeal with your insurance company when requested.
To be informed of utilization management criteria used to authorize, modify or deny healthcare services when requested.
Consumer Responsibilities:To be familiar with the benefits and exclusions of the consumer’s health plan coverage.
To provide the consumer’s healthcare provider with complete and accurate information regarding past illnesses, hospitalizations, medications and other matters related to health status.
To treat the utilization management staff with respect and dignity.