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 commercial 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 to care for them
  • Follow the plans and instructions for care that they have agreed upon with their practitioners
  • Understand their health problems and participate in developing mutually agreed-upon treatment goals to the degree possible

Publication Information

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,
Editor

Joseph O’Riordan,
Writer

Kristin Edmonston,
Production Coordinator