Member Rights and Responsibilities

Health Plan of Nevada is committed to ensuring that members are treated in a manner that respects their rights and promotes effective healthcare. Health Plan of Nevada has also identified its expectations of members’ responsibilities in this joint effort. Health Plan of Nevada’s statement regarding Members’ Rights and Responsibilities includes the following:

To be treated with respect and dignity and every effort made to protect your privacy.
To select a primary care provider from HPN’s extensive provider list including the right to refuse care from specific practitioners.
To be provided the opportunity to voice complaints or appeals about the plan and/or the care provided.
To receive information about the plan, its services, its providers, and members’ rights and responsibilities.
To participate with your primary care provider in the decision making process regarding your healthcare.
To make recommendations regarding the organization’s members’ rights and responsibilities policies.
To have a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
To have direct access to women’s health services for routine and preventive care.
To have direct access to medically necessary specialist care in conjunction with an approved treatment plan developed with the primary care physician. Required authorizations should be for an adequate number of direct access visits.
To have access to emergency healthcare services in cases where a “prudent layperson” acting reasonably, would have believed that an emergency existed.
To formulate Advance Directives.
To have access to your medical records in accordance with applicable state and federal laws.

Member’s Responsibilities

To know how HPN’s Managed Care Program operates.
To provide, to the extent possible, information that HPN and its providers need in order to provide the best care possible.
To take responsibility for maximizing health habits and to follow the healthcare plan that you, your physician and HPN have agreed upon.
To consult your primary care physician and HPN before seeking non-emergency care in the service area. We urge you to consult your physician and HPN when receiving urgently needed care while temporarily outside the HPN service area.
To obtain a written referral from your physician before going to a specialist, unless you are utilizing Point-of-Service benefits.
To obtain prior authorization from HPN and your physician for any routine or elective surgery, hospitalization, or diagnostic procedures.
To be on time for appointments and provide timely notification when canceling any appointment you cannot keep.
To pay all applicable copayments at the time of service.
To avoid knowingly spreading disease.
To recognize the risks and limitations of medical care and the healthcare professional.
To be aware of the healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients in the community.
To show respect for other patients, healthcare providers, and plan representatives.
To abide by administrative requirements of HPN, healthcare providers, and government health benefit programs.
To report wrongdoing and fraud to appropriate resources or legal authorities.
To know your medications. Keep a list and bring it with you to your appointment with our primary care provider.
To address medication refill needs at the time of your office appointment. When you obtain your last refill, notify the office that you will need refills at that time. Do not wait until you are out of your medication.
To report all side effects of medications to your primary care provider. Notify your primary care provider if you stop taking your medications for any reason.
To ask questions during your appointment time regarding physical complaints, medications, any side effects, etc.
To understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.