Member Rights & Responsibilities | Denver Health Medical Plan

Member Rights & Responsibilities

Member’s Rights:

  • Have access to practitioners and staff who are committed to providing quality health care to all members without regard for religion, race, national origin, handicap, sex or sexual orientation, or age.
  • Receive medical/behavioral health care that is based on objective scientific evidence and human relationships. A partnership based on trust, respect, and cooperation among the provider, the staff and the member will result in better health care.
  • To be treated with courtesy, respect, and recognition of your dignity and right to privacy.
  • To receive equal and fair treatment, without regard to race, religion, color, creed, national origin, age, sex, sexual preference, political party, disability, or participation in a publicly financed program.
  • To choose or change your primary care provider within the network of providers, to contact your primary care provider whenever a health problem is of concern to you and arrange for a second opinion if desired.
  • To expect that your medical records and anything that you say to your provider will be treated confidentially and will not be released without your consent, except as required or allowed by law.
  • Get copies of your medical records or limit access to these records, according to state and federal law;
  • Ask for a second opinion, at no cost to you;
  • To know the names and titles of the doctors, nurses, and other persons who provide care or services for the member.
  • A candid discussion with your provider about appropriate or medically necessary treatment options for your condition regardless of cost or benefit coverage.
  • A right to participate with providers in making decisions about your health care.
  • To request or refuse treatment to the extent of the law and to know what the outcomes may be.
  • To receive quality care and be informed of the DHMP Quality Improvement program.      
  • To receive information about DHMP, its services, its practitioners and providers and members’ rights and responsibilities, as well as prompt notification of termination or other changes in benefits, services or the DHMP network. This includes how to get services during regular hours, emergency care, after-hours care, out-of-area care, exclusions, and limits on covered service.
  • To learn more about your primary care provider and his/her qualifications, such as medical school attended or residency, go to www.denverhealthmedicalplan.org and click on Find a Doctor/Provider for our web based provider directory or call Member Services at 303-602-2100.
  • To express your opinion about DHMP or its providers to legislative bodies or the media without fear of losing health benefits.
  • To receive an explanation of all consent forms or other papers DHMP or its providers ask you to sign; refuse to sign these forms until you understand them; refuse treatment and to understand the consequences of doing so; refuse to participate in research projects; cross out any part of a consent form that you do not want applied to your care; or to change your mind before undergoing a procedure for which you have already given consent.
  • To instruct your providers about your wishes related to advance directives (such issues as durable power of attorney, living will or organ donation).
  • To receive care at any time, 24 hours a day, 7 days a week, for emergency conditions and care within 48 hours for urgent conditions.
  • To have interpreter services if you need them when getting your health care.
  • To change enrollment during the times when rules and regulations allow you to make this choice.
  • To have referral options that are not restricted to less than all providers in the network that are qualified to provide covered specialty services; applicable copays apply.
  • To expect that referrals approved by the Plan cannot be changed after Prior authorization or retrospectively denied except for fraud, abuse or change in eligibility status at the time of service.
  • To receive a standing referral, from a primary care provider to see a DHMP network specialty treatment center, for an illness or injury that requires ongoing care.
  • To make recommendations regarding DHMP’s Members’ Rights and Responsibilities’ policies.
  • To voice a complaint about or appeal a decision concerning the DHMP organization or the care provided and receive a reply according to the grievance/appeal process.

Member’s Rights for Pregnancy and Special Needs:

  • Receive family planning services from any licensed physician or clinic in the DHMP network.
  • To go to any participating OB/GYN in the DHMP network without getting a referral from your primary care provider.
  • To see your current non-network provider for prenatal care, until after delivery of the baby if you become a member of DHMP during your second or third trimester. This is dependent upon the non-network provider agreeing to accept DHMP’s arrangements.
  • To continue to see your non-network doctor(s) or provider(s), when medically necessary, for up to 60 days after becoming a DHMP member. (Dependent upon the non-network provider accepting DHMP’s arrangements for this transition.)

Member’s Responsibilities:

  • To treat providers and their staff with courtesy, dignity and respect.
  • To pay all premiums and applicable cost sharing (i.e. deductible, coinsurance, copays).
  • To make and keep appointments, to be on time, call if you will be late or must cancel an appointment, and to have your DHMP identification card available at the time of service and pay for any charges for non-covered benefits.
  • To report your symptoms and problems to your primary care provider and to ask questions, and take part in your health care.
  • To learn about any procedure or treatment and to think about it before it is done.
  • To think about the outcomes of refusing treatment that your primary care provider suggests.
  • To get a referral from your primary care provider before you see a specialist.
  • To follow plans and instructions for care that you have agreed upon with your provider.
  • To provide, to the extent possible, correct and necessary information and records that DHMP and its providers need in order to provide care.
  • To understand your health problems and participate in developing mutually agreed upon treatment goals to the degree possible.
  • To state your complaints and concerns in a civil and appropriate way.
  • Learn and know about plan benefits (which services are covered and non-covered) and to contact a DHMP Member Services representative with any questions.
  • Inform providers or a representative from DHMP when not pleased with care or service.