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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2017

Members’ Rights and Responsibilities


Harvard Pilgrim members receive a copy of the Members' Rights and Responsibilities upon enrollment, and all clinicians receive a copy at the time of contracting and credentialing and annually thereafter. Periodically, Harvard Pilgrim includes this information in Network Matters. Please take a moment to review. Because this information may vary among states, please be sure to read the full Rights and Responsibilities page of the Provider Manual.

Members have a right to:

  • Receive information about Harvard Pilgrim, its services, its practitioners, and providers, and members' rights and responsibilities
  • Be treated with respect and recognition of their dignity and right to privacy
  • Participate with practitioners in decision-making regarding their health care
  • Engage in a candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage
  • Voice complaints or appeals about Harvard Pilgrim or the care provided
  • Make recommendations regarding the organization’s members' rights and responsibilities policy

Members have a responsibility to:

  • Provide, to the extent possible, information that Harvard Pilgrim and its practitioners and providers need in order to care for them
  • Follow the 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.

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Network Matters Archives

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Reminder: Concurrent Review for Inpatient Stays

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Updates to Bariatric Surgeries Medical Review Criteria

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Update to Cardiac Event Monitors Medical Policy

Prescribing Statins to Members with Diabetes

Members’ Rights and Responsibilities

Biological Effects of Cannabis and Detriments to Adolescent Development

OFFICE ASSISTANT

Telemedicine/Telehealth Payment Policy

Change in Format of Newly Assigned Practitioner and Provider ID Numbers

Credentialing Reminder: Keep Provider Information Up to Date in CAQH

Keep Panel Status and Demographic Information Up to Date

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator