Participant Rights and Responsibilities

PA Health & Wellness, and its network of doctors and other providers of services, do not discriminate against Participants based on race, sex, religion, national origin, disability, age, sexual orientation, gender identity, or any other basis prohibited by law. As a Participant, you have the following rights and responsibilities.

Participants Rights and Responsibilities

PA Health & Wellness, and its network of doctors and other providers of services, do not discriminate against Participants based on race, sex, religion, national origin, disability, age, sexual orientation,gender identity, or any other basis prohibited by law. As a Participant, you have the following rights andresponsibilities.

Participant Rights

You have the right to:

  1. Receive information in a manner and format that you may easily understand and that is readily accessible to you.
  2. Receive accurate, easily understood information and assistance in making informed healthcare and Long-Term Services and Supports (LTSS) decisions about PA Health & Wellness, professionals, and facilities.
  3. A choice of healthcare and LTSS providers that is sufficient to ensure access to appropriate highquality healthcare.
  4. Access emergency health care services when and where the need arises.
  5. Fully participate in all decisions related to your healthcare and LTSS. If you are unable to fully participate in treatment decisions, you have the right to be represented by parents, guardians, family members, or other conservators.
  6. Considerate, courteous and respectful care from all members of the healthcare and LTSS system at all times and under all circumstances.
  7. Communicate with Providers in confidence and to have the confidentiality of your individually identifiable healthcare and LTSS information protected. You also have the right to review and copy your own medical and LTSS records and request amendments or corrections to your records.
  8. A fair and efficient process for resolving differences with PA Health & Wellness, healthcare and LTSS Providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review.
  9. Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in other Federal regulations on the use of restraints and seclusion.
  10. Receive information about services that PA Health & Wellness does not cover because of moral or religious objections.
  11. Exercise your rights, and the exercise of those rights may not adversely affect the way PA Health & Wellness and its providers treat you.

 

Participant Responsibilities

Participants have the responsibility to cooperate with those providing health care services. PA Health & Wellness requires your assistance to ensure that you receive necessary services and supports.

You have the responsibility to:

  1. Provide, to the extent possible, information needed by professional staff in caring for you.
  2. Follow instructions and guidelines given by those providing healthcare services.
  3. Take responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet.
  4. Become involved in specific healthcare decisions.
  5. Work collaboratively with healthcare and LTSS Providers in developing and carrying out agreedupon treatment plans.
  6. Disclose relevant information and clearly communicate wants and needs.
  7. Use PA Health & Wellness’s internal complaint and appeal processes to address concerns that may arise.
  8. Avoid knowingly spreading disease.
  9. Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.
  10. Be aware of a healthcare and LTSS Provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.
  11. Become knowledgeable about your health plan and LTSS coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
  12. Show respect for other patients, health workers, and LTSS workers.
  13. Make a good-faith effort to meet financial obligations.
  14. Abide by administrative and operational procedures of PA Health & Wellness, healthcare and LTSS Providers, and Government health benefit programs.
  15. Report wrongdoing and fraud to appropriate resources or legal authorities.

 

Participants shall provide consent to PA Health & Wellness, Healthcare Providers and their respective designees for providing patient care management, outcomes improvement and research. For these purposes, Participants will remain anonymous to the greatest extent possible.