June 2017  

Member Rights and Responsibilities

Blue Cross Medicare Advantage members have the right to timely, high quality care and treatment with dignity and respect. Participating providers must respect the rights of all members. Blue Cross Medicare Advantage members have been informed that they have the following rights and responsibilities:

• Choice of a qualified participating provider and hospital.
• Candid discussion of appropriate or medically necessary treatment options for their condition, regardless of cost or benefit coverage.
• Timely access to their participating provider, and recommendations to specialty providers when medically necessary.
• To receive emergency services when the member, as a prudent layperson, acting reasonably would believe that an emergency medical condition exists.
• To actively participate in decisions regarding their health and treatment options.
• To receive urgently needed services when traveling outside the Blue Cross Medicare Advantage service area or in the Blue Cross Medicare Advantage service area when unusual or extenuating circumstances prevent the member from obtaining care from a participating provider.
• To request the aggregate number of grievances and appeals and dispositions.
• To request information regarding provider compensation.
• To request information regarding the financial condition of Blue Cross Medicare Advantage.
• To be treated with dignity and respect and to have their right to privacy recognized.
• To exercise these rights regardless of the member’s race, physical or mental ability, ethnicity, gender, sexual orientation, creed, age, religion or national origin, cultural or educational background, economic or health status, English proficiency, reading skills, or source of payment for care.
• To confidential treatment of all communications and records pertaining to the member’s care.
• To access, copy and/or request amendment to the member’s medical records consistent with the terms of HIPAA. To extend their rights to any person who may have legal responsibility to make decisions on the member’s behalf regarding the member’s medical care.
• To refuse treatment or leave a medical facility, even against the advice of providers (providing the member accepts the responsibility and consequences of the decision).
• To complete an Advance Directive, living will or other directive to the member’s providers.

Blue Cross Medicare Advantage members have been informed that they have the following responsibilities:

• To become familiar with their coverage and the rules they must follow to receive care as a Blue Cross Medicare Advantage member;
• To give their providers the information they need to care for the member, and to follow the treatment plans and instructions that the member and his/her provider agree upon;
• To be sure to ask their provider if they have any questions;
• To act in a way that supports the care given to other patients and to help the smooth running of their provider’s office, hospitals, and other offices;
• To pay their plan premiums and any copayments they may owe for the covered service they receive. They must also meet their financial responsibilities; and
• To let Blue Cross Medicare Advantage know if they have any questions, concerns, problems or suggestions.

Blue Cross Medicare Advantage and Blue Cross Medicare Advantage Dual Care plans are HMO, HMO-POS, PPO, and HMO Special Needs Plans provided by Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract and a contract with the New Mexico Medicaid program. Enrollment in HCSC’s plans depends on contract renewal.