Member Rights and Responsibilities

As a member of Priority Health, you have certain rights. Some of the most important ones are the right to privacy, to receive prompt medical care and to have the information you need to make decisions about your treatment. To help us be sure you get the best care and service, you have some responsibilities as a member. Here is a summary of your rights and responsibilities.

As a member of Priority Health, you have the following rights:

• You may receive prompt medical care appropriate to your condition, including emergency care if necessary.
• You may receive information regarding appropriate or medically necessary treatment options which will enable you to make an informed decision about the treatment you receive, regardless of cost or benefit coverage.
• You may receive information about us, our services, our providers and member rights and responsibilities.
• You may participate in decisions regarding your health care.
• We will treat you with respect.
• We will protect your privacy.
• We will keep your medical and financial records maintained by us confidential, whether in electronic or written form.
• We will not disclose information from your medical records without your consent, except when required by law, in connection with the administration of Priority Health, or for anonymous use in statistical studies and medical research.
• You may inspect your medical records and those of your minor dependents at the office of the proper provider during normal business hours. The provider may limit a parent's or legal guardian's access to a minor's medical records without the minor's consent, as provided by law.
• You may contact us to discuss concerns about the quality of care you have received from a Participating Provider.
• You may register a complaint or file a grievance with us or the State of Michigan, if you experience a problem with us or a provider.
• You may file a fair hearing request.
• You may initiate a legal proceeding if you experience a problem with us or a provider after you have exhausted the grievance process.
• We will notify you in a timely manner if we release personal information about you in response to a court order.
• You may review a summary of Priority Health's annual report, and inspect the full report on file with the Michigan Department of Community Health or the Office of Financial and Insurance Services.
• You may suggest changes to our Member Rights and Responsibilities policies.

As a member you also have the following responsibilities

• You must read the Certificate of Coverage and member materials, and comply with the requirements.
• You must call us with questions.
• You must coordinate all medical services through your Primary Care Physician (PCP) except in the case of a medical emergency.
• You must obtain prior approval from your PCP and Priority Health for services as noted in your Certificate of Coverage, including all services from providers who are not listed in Priority Health's Provider Directory, and comply with the limits of any approval of services.
• You must receive a physical examination from your PCP within one year of joining Priority Health.
• You must use Participating Providers (doctors, hospitals, and other health care providers in the Priority Health Medicaid plan network) for all services and equipment not requiring prior approval.
• You must contact Participating Providers  to arrange for medical appointments, and notify providers in a timely manner if an appointment must be canceled.
• You must present your ID Card to the provider before you receive a service.
• You must pay copayments at the time service is provided to you.
  
• You must participate in your health care as much as possible by working to understand your health problems.
• You must follow the treatment goals and other instructions given to you by your doctor, hospital, or other health care provider. You may participate in developing your treatment goals when possible. Priority Health or your providers may ask you to enter into an explicit written agreement to ensure you understand the instructions.
• You must supply, to the extent possible, information needed by us and health care professionals to provide proper care.
• You must notify providers and us if you have other health insurance coverage.
• You must provide truthful information in any other information provided to us.
• You must promptly notify us of any change in address.
• You must promptly notify us if your ID card is stolen.
• You must cooperate with us to prevent the unauthorized use of your ID card and to prevent anyone from obtaining benefits in your place.
• You must treat your health care providers and their staffs with respect.