Legal

Member Rights and Responsibilities

As a Network Health member, you have certain rights and responsibilities. We try to make sure we provide you with services that respect your rights.

You have the right to:

  • Receive information about the managed care organization, its services, practitioners and providers.
  • Be treated with respect and recognition of your dignity and your right to privacy.
  • Participate with practitioners in decision making about your health care.
  • Discuss appropriate or medically necessary treatment options for conditions, regardless of cost or benefit coverage.
  • Voice complaints or appeals about the managed care organization, the care received and/or the privacy of protected health information.
  • Select or change a primary care practitioner for any reason.
  • Timely access to your covered services
  • Review medical records with your primary care practitioner.
  • Receive prompt and courteous service from representatives regarding benefits, eligibility, claims or other Network Health matters.
  • Be informed of your diagnosis, treatments and prognoses from practitioners in terms you understand.
  • Refuse treatment and to know of the probable consequences of that action.
  • Make recommendations about the organization’s member rights and responsibilities

Your responsibilities are to:

  • Communicate openly with providers or health plan personnel. If you have questions about your treatment plan, it’s your responsibility to discuss concerns and understand any explanation or instructions.
  • Read and understand your benefits as outlined in the policy materials.
  • Follow the policies and procedures that we’ve established in your certificate of coverage or evidence of coverage (policy)
  • Follow the plans and instructions for care that you and your practitioner have agreed to.
  • Treat all providers and health plan personnel with respect and courtesy.
  • Provide information that health care professionals need to take care of you.
  • Notify providers and Network Health of changes in coverage, eligibility, addresses or phone numbers.
  • Tell us if you have any other health insurance coverage in addition to our plan
  • Keep scheduled appointments or to give proper notice of delay or cancellation.
  • Express concerns of dissatisfaction with us or your providers so we can fix the situation.
  • Understand your health problems and participate in developing mutally agreed-upon treatment goals, to the degree possible.
  • Know which providers are in network prior to accessing services. Our Find a Doctor tool is the most up-to-date source for this information. 
  • Obtain an authorization from Network Health Care Management for any services you wish to obtain from non-participating practitioners and providers. (HMO Policies)
  • Pay what you owe, including your monthly premiums and your share of the cost for medical services.

Network Health
1570 Midway Place
Menasha, WI 54952
Hours
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.