NCPPO and HealthLink believes that health care should be physician-driven and based on a strong relationship
between doctor and patient. The following lists of Enrollee Rights and Responsibilities
acknowledge some fundamental elements of this relationship.
Enrollee Rights
- To receive considerate and respectful care and services from participating physicians,
hospitals and other health care professionals, and considerate and respectful services
from NCPPO and HealthLink staff.
- To receive medically necessary care and services.
- To receive from your physician (or hospital/office personnel) complete and understandable
information about your condition, possible treatments and likely outcome, and to discuss
this information with your physician. No restriction shall be placed on the dialogue
between practitioner and patient.
- To participate in any decision-making related to your care.
- To know the names and roles of the people treating you.
- To consent to or refuse a treatment as permitted by law. If you refuse a recommended
treatment, you will receive other needed, reasonable and available care.
- Consideration of privacy concerning your medical care. Case discussion, consultations
and treatments should be conducted discreetly, with only necessary individuals present.
- To have all communications and records pertaining to your care treated as confidential,
released only with your permission, or as permitted by law.
- To review your medical records and to have the information explained, except when restricted
by law.
- To be informed of complaint and grievance procedures, and to file a complaint when
you are dissatisfied with the health care you or a family member receives.
- To receive information about NCPPO and HealthLink, its services and participating network physicians,
hospitals and other health care professionals in a clear and concise manner.
Enrollee Responsibilities
- To select and establish a relationship with a medical practitioner.
- To seek medical care at the earliest possible time when you experience symptoms that
may indicate illness or injury.
- To provide, to the best of your knowledge, accurate and complete information about
present complaints, past illnesses, hospitalizations, medications or other matters
concerning your health.
- To communicate to medical personnel if you do not clearly understand what is expected
of you, or how to take prescribed medication.
- To follow the treatment plan recommended by the physician primarily responsible for
your care. Keep scheduled appointments. Take medications as prescribed, or communicate
your reason for not doing so to your doctor. Adhere to any prescribed diet or exercise
program, or consult with the prescribing health care professional to adjust the requirements
or resolve problems.
- To recognize the effects of lifestyle and preventive care in your personal health.
- To read the benefit program information provided to you and to follow instructions
regarding claims, eligibility and hospitalizations.
- To carry your health identification card and identify yourself as an enrollee of a
health plan that uses NCPPO and HealthLink's network programs when you seek health care services.
- To provide, to the best of your knowledge, accurate and complete information about
your current health coverage to physicians, hospitals and other health care professionals
who treat you.
National Capital Preferred Provider Organization, Inc. ("NCPPO") is a Maryland corporation. HealthLink®, Inc., is an Illinois corporation.
Both are organizers of independently contracted provider networks, which are made available by contract to a variety of payors of health benefits, including
insurers, third party administrators or employers. Neither has control nor right of control over the professional, medical judgment of contracted providers,
nor are they liable for any acts or failures to act, by contracted providers. Neither is an insurance company and neither has liability for benefits under
benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc. Both companies are subsidiaries of WellPoint, Inc.
