Your rights and responsibilities as a Priority Health member

As a Priority Health Medicare member, you have several rights and responsibilities when it comes to your plan and your health. It's important to understand your rights and responsibilities to ensure you get the most our of your Priority Health Medicare plan.

Your rights as a member of a Priority Health Medicare plan

You have the right to:

  • Prompt medical care appropriate for your condition, including emergency care if necessary.
  • Discuss all treatment options available to you, regardless of what your plan covers.
  • Information about us, our services, our health care providers and your rights and responsibilities.
  • Collaborate with physicians and other health care providers when making decisions about the care you receive.
  • Be treated with respect.
  • Have your privacy protected.
  • Have your medical and financial records be kept confidential, whether in electronic or written form. We will not disclose information from your medical records without your consent, except as allowed. Read our Notice of Privacy Practices for more information about this.
  • Be notified quickly if we release information about you in response to a court order.
  • Inspect your medical records and those of your minor dependents. Your right as a parent or legal guardian to see your minor dependent's medical records without the minor's consent may be limited by state or federal law.
  • Register a complaint or file a grievance with us, or with the Commissioner of the Office of Financial and Insurance Regulation, if you experience a problem with us or with a health care provider. For more information, go to the Grievances & appeals section of this website.
  • Initiate a legal proceeding if you experience a problem with us or with health care providers after you have exhausted the grievance process.
  • Review a summary of Priority Health's annual report, and inspect the full report on file with the Office of Financial and Insurance Regulation.
  • Suggest changes to our Member Rights and Responsibilities policies.

Your responsibilities as a member of a Priority Health Medicare plan

You can find a complete list of your responsibilities as a Priority Health medical plan member in the Evidence of Coverage document for your plan. You are responsible for:
  • Reading the coverage documents that explain your health plan and the accompanying member materials.
  • Understanding and complying with the terms and conditions of your plan.
  • Calling us with questions.
  • If you have an HMO-POS plan, coordinating all medical services through your primary care physician (PCP) or other primary health care provider, except in the case of a medical emergency.
  • Using participating health care providers for all services and supplies not requiring prior approval, or, if your plan allows you to use non-participating/out-of-network providers, then understanding the costs of services you choose to get from them. "Participating providers" are health care providers that are contracted to accept your Priority Health plan. They are listed in the Find a Doctor online provider directory.
  • Getting prior approval for medical services when required by your plan and complying with the limits of any approval of services. Note: Services that generally require pre-approval or "prior authorization" are listed in the Evidence of Coverage document for your plan.
  • Contacting participating health care providers to arrange for medical appointments, and notifying them in a timely manner if an appointment must be canceled.
  • Paying copayments at the time service is provided.
  • Presenting your Priority Health membership card to a health care provider before you receive a service.
  • Collaborating with your doctors and other health care providers to make informed decisions about the care you receive and to understand your health problems and health risks.
  • Following the instructions and working toward the treatment goals that you and your doctor or other health care provider agree upon. You may participate in developing your treatment goals when possible. Priority Health or your health care providers may ask you to agree to a written treatment plan to ensure you understand it.
  • Supplying your doctors and other health care providers and Priority Health with the information we need to make sure you receive proper care.
  • Notifying health care providers and us if you have other health insurance coverage.
  • Providing accurate information on your application or enrollment form and in any other information provided to us.
  • Notifying us when your address changes.
  • Notifying us if your Priority Health membership card is stolen.
  • Cooperating with us to prevent the unauthorized use of your Priority Health membership card and to prevent anyone from using your benefits in your place.
  • Treating health care providers and their staffs with respect.