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Member Rights and Responsibilities

Your Rights:

  • Right to high quality health services.
  • Rights regarding the obtaining and disclosing of information.
  • Rights regarding the selection of plans and providers.
  • Patient’s right to the continuity of health care services.
  • Right regarding access to emergency services and facilities.
  • Right to participate in the decision-making process regarding your treatment.
  • Right regarding respect and the same treatment.
  • Right to confidentiality of information and medical records.
  • Rights regarding complaints and grievances.

Your Responsibilities:

  • To provide the necessary information about medical plans and the payment of any account. To know the rules of Coordination of Benefits and notify the insurer about any instance or suspicion of fraud against the health plan.
  • To provide the most complete and precise information, including previous diseases, medications, etc. To participate in every decision regarding your medical care. To know the risks and limits of medicine.
  • To know the coverage, options, and benefits and other details of the health plan.
  • To comply with your health plan administrative procedures.
  • To notify the physicians of unexpected changes in your condition.
  • To adopt a healthy lifestyle.
  • To make known that you clearly understand the course of action recommended by the health professional.
  • To provide a copy of your advance directives.
  • To notify the physician if you anticipate problems with the prescribed treatment.
  • To recognize the obligation of the provider to be efficient and equitable when providing services to other patients.
  • To be considerate, so that your particular behavior does not affect other person.
  • To solve any difference through the procedures established by the insurance company.

MEMBER’S RIGHTS AND
RESPONSIBILITIES
Law 194 of August 25, 2000, as amende