Quality

Rights & Responsibilities

As a member of Senior Whole Health of New York, you have certain rights and responsibilities.

 

Your rights include:
  • To receive information about Senior Whole Health of New York’s services, practitioners and providers, enrollment, informational or instructional materials, grievance and appeal rights and member’s rights and responsibilities annually in a manner appropriate to their condition and ability to understand;
  • To receive reasonable accommodations if required;
  • To be treated with respect and recognition of their dignity and their right to privacy;
  • To participate with practitioners in making decisions about their healthcare including the right to refuse treatment;
  • To participate in a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage;
  • To voice complaints or appeals about Senior Whole Health of New York or the care provided;
  • To make recommendations regarding Senior Whole Health of New York’s member rights and responsibility policy;
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation;
  • To request and receive a copy of his or her medical record and request that the record be amended or corrected;
  • To not be balanced billed by a provider for any service;
  • To receive services in a culturally competent manner and non-discriminatory manner;
  • To receive updates and/or changes to the rights and responsibilities at least annually;
  • To exercise their member rights without negative consequences.
The member responsibilities include the responsibility to:
  • Provide, to the extent possible, information that Senior Whole Health of New York and its practitioners and providers need in order to care for a member;
  • Follow the plans and instructions for care that the member has agreed upon with the practitioner or provider;
  • Understand a member’s health problems and participate in developing mutually agreed upon treatment goals and care plans;
  • Get familiar with the covered services and the rules a member must follow to obtain the covered services;
  • Inform Senior Whole Health of New York if there is any other health insurance coverage or prescription drug coverage in addition to the Senior Whole Health of New York plan;
  • Tell the member’s doctor and other healthcare providers that the member is enrolled in a Senior Whole Health of New York plan;
  • Help doctors and other providers help the member by giving the doctors and providers information, asking questions, and following through on the care plan;
  • Be considerate by respecting the rights of other patients and acting in a way that is respectful of a healthcare practitioner or provider and the staff;
  • Pay any healthcare bills that are owed;
  • Tell Senior Whole Health of New York if there is a change of residence; and
  • Call Member Services for help when there are questions or concerns.

Enrollee Advisory Council

Senior Whole Health of New York would like you to help us improve our health plan. Please consider joining the Enrollee Advisory Council and weigh in on things that matter to members. This is open to both members and their care givers.

If you are interested call 1-877-353-0185. We will reach out to you with information about our next meeting. We’ll even arrange transportation.