Member Rights and Responsibilities
Members of WellFirst Health — Provided by SSM Health Plan — deserve the best service and health care possible. We are committed to maintaining a mutually respectful relationship with its members.
Rights and responsibilities help foster cooperation among members, practitioners and our health plan. These Member Rights and Responsibilities, outlined below, also appear annually in our provider and member newsletters.
Our members have the right to:
- Be treated with respect and recognition of their dignity and their right to privacy.
- Receive a listing of our participating practitioners in order to choose a primary care provider.
- Present a question, complaint, or grievance to us about the organization or the care it provides without fear of discrimination or repercussion.
- Receive information on procedures and policies regarding their health care benefits.
- Timely responses to requests regarding their health care plan.
- Request information regarding Advance Directives.
- Participate with practitioners in making decisions about their health care.
- A candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
- Receive information about the organization, its services, its practitioners and providers, and members’ rights and responsibilities.
- Make recommendations regarding the organization’s members’ rights and responsibilities policies.
- Receive a copy of the our Notice of Privacy Practices, which describes how medical information about you may be used or disclosed and how you can get access to this information.
Our members have the responsibility to:
- Read and understand the materials we provide concerning their health care benefits. We encourage members to contact us if they have any questions.
- Present their ID card in order to identify themselves as a member before receiving health care services.
- Notify us of any enrollment status changes such as family size or address.
- Supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
- Follow plans and instructions for care that they have agreed on with their practitioners.
- Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible.
- Fulfill financial obligations as it relates to any copays, deductibles and/or premiums as outlined in your policy.