HBI endeavors to ensure that our patients/members and providers are aware of their rights and responsibilities when accessing services at HBI Staff Model Clinics and network practitioners. HBI provides services without regard to race, national origin, creed, color, sex, religion, age, disability, handicap condition or health status except when medically indicated.
You, as a Member/Patient have the RIGHT to:
- Receive information about the managed care organization, services, provider network, credentials criteria, clinical guidelines and Consumer rights and responsibilities.
- Be treated with respect and dignity and the right to privacy.
- Be free to exercise your rights and to be treated fairly based on other Federal and State laws such as:
- Age Discrimination Act of 1975
- Civil Rights Act of 1964
- Rehabilitation Act of 1973
- Titles II and III of the Americans with Disabilities Act
- Health Insurance and Portability Act of 1996 ( HIPAA)
- Attend a discussion of appropriate or medically necessary treatment options and/or an explanation regarding what is not medically necessary regardless of cost or benefit coverage.
- Be free from any form of restraint or seclusion used as a means of constraint, discipline, convenience or retaliation.
- All covered benefits and to be treated timely by qualified providers who speak your language and understand your culture whenever possible.
- Have a second opinion from a qualified contracted provider or from a non-contracted provider if services are not available from a contracted provider.
- Make decisions regarding the use of life sustaining treatment, so long as you are able to do so and to refuse or abruptly terminate treatment to the extent permitted by law and to receive an explanation from your provider regarding any consequences that may result from either refusal or abrupt termination of care.
- Confidentiality of your treatment records to the extent protected by State and Federal laws and HIPAA regulations, unless the member/patient signs a release of information. Members/Patients are also entitled to receive an explanation regarding exceptions to confidentiality.
- Access your treatment records and to request corrections to the records based on Federal and State laws.
- Voice complaints or to appeal the Human Behavior Institute on the care provided, to your insurance carrier, the HBI appeals department or in certain instances to the Insurance Commissioner and receive prompt resolution.
- Be provided, upon request, with the information about your plan’s benefit and fee structure, including limitations, exclusions, the practitioners providing care, information about physician incentive plans if any exist, and Advanced Directives.
- Receive prompt, competent and courteous treatment from all Human Behavior Institute staff and network providers and in turn Members/Patients have the responsibility to demonstrate respect and courtesy towards practitioners and office personnel.
- Make suggestions and give comments on ways that HBI can improve policies, procedures and services.
You, as a Member/Patient have the RESPONSIBILITY to:
- Read your own insurance certificate or evidence of coverage or other materials outlined in your behavioral health care coverage, including requirements about accessing mental health and addictions care. If you do not understand the information, you should ask questions either to your insurance company or the HBI staff to help you understand covered benefits, limitations and authorization procedures.
- Bring your ID card or Medicaid card to every appointment and show a photo ID if requested by the clinician’s office.
- Give a copy of your Durable Power of Attorney and should provide a copy of your Advance Directive to your provider, if they have chosen to have one.
- Know the name and office contact information of your doctor or mental health provider.
- Provide, to the extent possible, clinical and psychosocial information to HBI and network providers, in order to render a proper clinical evaluation and treatment plan. This includes providing information about your current problems, past illnesses, hospitalizations, medications, and other information important to your health care.
- Actively participate in and follow through with your treatment plan to achieve goals that are mutually agreed upon when therapy is initiated.
- Understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.
- Cancel or change appointments within the guidelines established by HBI and network providers.
- Pay insurance applicable co-payments at the time of service. Medicaid plans are not charged a co-pay or deductible
- Request for translation services from an appropriate, clinically trained translator, when receiving mental health services, including member services and therapy services.
Your HIPAA Rights, as a Member/Patient:
- Request and receive confidential communications of Protected Health Information (PHI) by alternative means and at alternative location. (For example, you may not want a family member to know that you are a patient at HBI. Upon your request, HBI will send your bills to another address.)
- Inspect or obtain a copy (or both) of your PHI of mental health and billing records used to make decisions for as long as the PHI is maintained in the record. (HBI may deny access to PHI under certain circumstances, but you may have this decision reviewed in the HBI appeal process.
- Request an amendment of PHI for as long as the PHI is maintained in the record. HBI may deny your request but you have the right to appeal this decision in the HBI appeal process.
- Receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as permitted by HIPAA regulations) HBI will discuss with you the details of the accounting process. The member/patient has the right to obtain a paper copy of the notice of accounting, upon request.
- Appeal to HBI if you believe that HBI has violated your privacy rights.
- Send a written complaint to the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated by HBI.