Customer Rights and Responsibilities

Medicare customers have the right:

• To be treated with respect and in a manner that recognizes their need for privacy and dignity.
• To receive assistance in a prompt, courteous, responsible and culturally competent manner.
• To be provided with information about their health care benefits and any limitations and exclusions associated with their coverage.
• To be informed by their physician or other health care professional of their diagnosis, prognosis and plan of treatment in terms they understand.
• To participate in decisions with their physician regarding their care.
• To expect the Plan not to interfere with any contracted physician’s or health care professional’s discussion with them about their treatment options whether covered or not.
• To have the Plan refer them to another contracted physician or health care professional if their physician or health care professional objects to a treatment based on moral or religious grounds.
• To be provided with information about the network of contracted physicians and health care professionals in their service area.
• To be informed by their physician or other health care professional about any treatment they may receive.
• To have their physician or health care professional request their consent for all treatment, unless there is an emergency and they are unable to sign a consent form and their health is in serious danger.
• To refuse treatment, including any experimental treatment, and be advised of the probable consequences of their decision.
• To choose an advance directive to designate the kind of care they wish to receive should they become unable to express their wishes.
• To select, without interference, a primary care physician of their choice from within the Plan’s network of contracted physicians.
• To make recommendations regarding our member rights and responsibilities policy.
• To express a complaint about the Plan.
• To express a complaint about the care they have received and to receive a response in a timely manner.
• To initiate the grievance procedure if they are not satisfied with their Plan’s decision regarding their complaint.
• To receive “timely access” to the records and information that pertains to them.

The following are your rights with respect to your health information:

• You have the right to ask to restrict uses or disclosures of your information for treatment, payment, or health care operations. You also have the right to ask to restrict disclosures to family members or to others who are involved in your health care or payment for your health care. We may also have policies on dependent access that authorize your dependents to request certain restrictions. Please note that while we will try to honor your request and will permit requests consistent with our policies, we are not required to agree to any restriction.
• You have the right to request that a provider not send health information to us in certain circumstances if the health information concerns a health care item or service for which you have paid the provider out of pocket in full.
• You have the right to ask to receive confidential communications of information in a different manner or at a different place (for example, by sending information to a P.O. Box instead of your home address). We will accommodate reasonable requests where a disclosure of all or part of your health information otherwise could endanger you. We will accept verbal requests to receive confidential communications, but requests to modify or cancel a previous confidential communication request must be made in writing. Mail your request to the address listed below.
• You have the right to see and obtain a copy of health information that may be used to make decisions about you such as claims and case or medical management records. You also may in some cases receive a summary of this health information. You must make a written request to inspect and copy your health information. Mail your request to the address listed below. In certain limited circumstances, we may deny your request to inspect and copy your health information. We may charge a reasonable fee for any copies. If we deny your request, you have the right to have the denial reviewed. As of February 17, 2010, if we maintain an electronic health record containing your health information, you have the right to request that we send a copy of your health information in an electronic format to you or to a third party that you identify. We may charge a reasonable fee for sending the electronic copy of your health information.
• You have the right to ask to amend information we maintain about you if you believe the health information about you is wrong or incomplete. Your request must be in writing and provide the reasons for the requested amendment. Mail your request to the address listed below. If we deny your request, you may have a statement of your disagreement added to your health information.
• You have the right to receive an accounting of certain disclosures of your information made by us during the six years prior to your request. This accounting will not include disclosures of information made: (i) prior to April 14, 2003; (ii) for treatment, payment, and health care operations purposes; (iii) to you or pursuant to your authorization; and (iv) to correctional institutions or law enforcement officials; and (v) other disclosures for which federal law does not require us to provide an accounting.
• You have the right to a paper copy of this notice. You may ask for a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You also may also obtain a copy of this notice at our website, www.myuhc.com.

Exercising Your Rights

• Contacting your Medicare Advantage Health Plan. If you have any questions about this notice or want to exercise any of your rights, please call the phone number on the back of your ID card or you may contact Customer Service at 1-866-550-4736 (TTY: 711), October 15, 2011 – March 1, 2012: 8 a.m. – 8 p.m., local time, 7 days a week; and March 2, 2012 – October 14, 2012: 8 a.m. – 8 p.m., local time, Monday – Friday.
• Submitting a Written Request. Mail to us your written requests for modifying or cancelling a confidential communication, for copies of your records, or for amendments to your record, at the following address:
  
  UnitedHealth Group
  PSMG Privacy Office
  MN0006-W008
  P.O. Box 1459
  Minneapolis, MN 55440
• Filing a Complaint.If you believe your privacy rights have been violated, you may file a complaint with us at the address listed above.

You may also notify the Secretary of the U.S. Department of Health and Human Services of your complaint. We will not take any action against you for filing a complaint.

Medicare customers have the responsibility:

• To know and confirm your benefits prior to receiving treatment.
• To show your Medicare plan ID card before receiving services and to protect against the wrongful use of your ID card by another person.
• To verify that the physician or health care professional you receive services from is participating in the Medicare network.
• To keep scheduled appointments and pay any necessary copayments/coinsurance at the time you receive treatment.
• To ask questions and seek clarification until you understand the care you are receiving.
• To follow the advice of your physician or health care professional and be aware of the possible consequences if you do not.
• To express your opinions, concerns and complaints to us.
• To provide information as necessary to the Plan and contracted physicians and health care professionals that would help enhance your health status.
• To use emergency room services only for an injury or illness that appears to pose a serious threat to your life or health if not treated immediately.
• To follow the treatment plan agreed upon by you and your physician.
• To treat all Plan personnel respectfully and courteously.
• To notify us of any change in address.

If you have questions or concerns about your rights, or need help with communication, such as assistance from a language interpreter, please call Customer Service at 1-866-550-4736 (TTY: 711), October 15, 2011 – March 1, 2012: 8 a.m. – 8 p.m., local time, 7 days a week; and March 2, 2012 – October 14, 2012: 8 a.m. – 8 p.m., local time, Monday – Friday.

The Medicare program has written a booklet called Your Medicare Rights and Protection. To get a free copy, call 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048, 24 hours a day, 7 days a week. Or you can access the Medicare website, www.medicare.gov, to order the booklet or print it from your computer.