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Members

Consumer Rights and Responsibilities

You have rights and responsibilities as a consumer or member of Memorial Hermann Health Solutions or Memorial Hermann Health Insurance Company. As a parent, caretaker, or legal guardian of a juvenile consumer or member, you have rights and responsibilities, as well as liability.

You have the right to:

  • Receive coverage for covered medical benefits and treatment that are available when you need them and are handled in a way that is fair, and respects your privacy and dignity.
  • Receive information you need about your health benefit plan, including information about services that are covered and not covered and any costs that you will be responsible for paying, in a language you understand, including that language in written form when requested.
  • Receive covered services. Your race, ethnic group, original country, language, religion, gender and age do not matter. Your mental or physical problems, sexual orientation and family medical history do not matter.
  • Obtain information about the qualifications of clinical staff that support Memorial Hermann Health Solutions and Memorial Hermann Health Insurance Company programs and services.
  • Have access to a current list of in-network doctors, hospitals and places you can receive care and information about a particular doctor's education, training and practice.
  • Select a primary care doctor for yourself and each covered member of your family per your benefit plan, and change your primary care doctor for any reason.
  • Have your medical information kept confidential by Memorial Hermann Health Solutions and Memorial Hermann Health Insurance Company and your doctor. Memorial Hermann Health Solutions and Memorial Hermann Health Insurance Company complies with the confidentiality of all consumers' information and adheres to all federal and state regulations regarding confidentiality and the release of personal health information.
  • Participate with your healthcare professional in treatment decisions and have your healthcare professional give you information about your medical condition and your treatment options/risk, regardless of coverage or cost. Members who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members or other conservators. You have the right to receive this information in terms and language you understand.
  • Be asked for your consent for all care, unless there is an emergency and your life and health are in serious danger, and learn about any care you receive.
  • Be advised of who is available to assist you with any special Memorial Hermann Health Solution or Memorial Hermann Health Insurance Company programs or services you receive and who can assist you with any requests to change programs or services.
  • Access emergency healthcare services when and where the need arises.
  • Refuse medical care. If you refuse medical care, ask what happens if you refuse treatment. We urge you to discuss your concerns about care with your primary care doctor or other participating healthcare professional. Your doctor or healthcare professional will give you advice, but you will have the final decision.
  • A fair, efficient and reasonable process for resolving differences of your complaint(s) or concern about Memorial Hermann Health Solution or Memorial Hermann Health Insurance Company and/or the quality of care you receive from healthcare professionals and the various places you receive care in our network; provide a courteous, prompt response; including guidance through our grievance process if you do not agree with our decision.
  • Make recommendations regarding Memorial Hermann Health Solution or Memorial Hermann Health Insurance Company policies that affect your rights and responsibilities.

You have the responsibility to:

  • Review and understand the information you receive about your health benefit plan and any rules for getting care. Please call Consumer Service when you have questions or concerns.
  • Understand how to obtain services and supplies that are covered under your plan.
  • Show your ID card before you receive care and not allow anyone else to use your ID card with the purpose of fraud and abuse.
  • Respect the healthcare professionals who are giving you care and follow their advice.
  • Schedule an appointment with any in-network healthcare professional for care needed, build a comfortable relationship with your doctor, ask questions about things you don't understand and follow your doctor's advice. Know that your condition may not improve and may even get worse if you don't follow your healthcare professional's advice.
  • Understand your health condition and work with your doctor to develop a treatment plan with goals that you both agree upon. Ask for more information if you do not understand your health condition or treatment.
  • Provide honest, complete information to the healthcare professionals caring for you. Know that dishonesty compromises your healthcare.
  • Know what medicine you take, and why and how to take it.
  • Pay all co-pays, deductibles and coinsurance for which you are responsible at the time service is rendered or when they are due.
  • Keep scheduled appointments and notify the healthcare professional's office ahead of time if you are going to be late or miss an appointment.
  • Pay all charges for missed appointments and for services that are not covered by your plan.
  • Voice your opinions, concerns or complaints to Memorial Hermann Health Solutions Consumer Service or Memorial Hermann Health Insurance Company Customer Service and/or your healthcare professional.
  • Notify Memorial Hermann Health Solutions or Memorial Hermann Health Insurance Company and your treating healthcare professional as soon as possible about any changes in family status, address, phone number or status with other health benefit coverage.