Member Rights & Responsibilities

Below are the Senior Whole Health of New York rights and responsibilities as written in the Senior Whole Health of New York Member Handbook. New York law requires that healthcare providers or healthcare facilities recognize member rights while they are receiving medical care and that members respect the provider's or health care facility's right to expect certain behavior on the part of patients.

Senior Whole Health of New York Member Rights & Responsibilities Statement

Member rights include the right to:

  • Receive medically necessary care.
  • Receive timely access to care and services.
  • Privacy about your medical record and when you get treatment.
  • Access information on available treatment options and alternatives presented in a manner and language you understand.
  • Receive Information in a language you understand; you can get oral translation services free of charge.
  • Receive Information necessary to give informed consent before the start of treatment.
  • Be treated with respect and dignity.
  • Access to a copy of your medical records and ask that the records be amended or corrected.
  • Take part in decisions about your health care, including the right to refuse treatment.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • Receive care without regard to sex, race, health status, color, age, national origin, sexual orientation, marital status or religion.
  • Be told where, when and how to get the services you need from your managed long term care plan, including how you can get covered benefits from out-of-network providers if they are not available in the plan network.
  • Complain to the New York State Department of Health or your Local Department of Social Services; and, the right to use the New York State Fair Hearing System and/or a New York State External Appeal, where appropriate.
  • Appoint someone to speak for you about your care and treatment.
  • Seek assistance from the Participant Ombudsman program.

Member responsibilities include the responsibility to:

  • Receive covered services through SWH of NY;
  • Use SWH of NY network providers for covered services to the extent network providers are available;
  • Obtain prior authorization for covered services, except for pre-approved covered services or in emergencies; Being seen by your physician, if a change in your health status occurs;
  • Share complete and accurate health information with your health care providers;
  • Inform SWH of NY staff of any changes in your health, and making it known if you do not understand or are unable to follow instructions;
  • Follow the plan of care recommended by the SWH of NY staff (with your input);
  • Cooperate with and being respectful with the (SWH of NY) staff and not discriminating against SWH of NY staff because of race, color, national origin, religion, sex, age, mental or physical ability, sexual orientation or marital status;
  • Notify SWH of NY within two business days of receiving non-covered or non-pre-approved services;
  • Notify your SWH of NY health care team in advance whenever you will not be home to receive services or care that has been arranged for you;
  • Inform SWH of NY before permanently moving out of the service area, or of any lengthy absence from the service area;
  • Your actions if you refuse treatment or do not follow the instructions of your caregiver;
  • Meet your financial obligations.

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