You have the right:
1. To be treated with respect, recognizing your dignity and need for privacy, by
Highmark Wholecare staff and network providers.
2. To get information in a way that you can easily understand and find help when
you need it.
3. To get information that you can easily understand about Highmark Wholecare, its
services, and the doctors and other providers that treat you.
4. To pick the network health care providers that you want to treat you.
5. To get emergency services when you need them from any provider without
Highmark Wholecare’s approval.
6. To get information that you can easily understand and talk to your providers
about your treatment options, risks of treatment, and tests that may be selfadministered without any interference from Highmark Wholecare.
7. To make all decisions about your health care, including the right to refuse
treatment. If you cannot make treatment decisions by yourself, you have the
right to have someone else help you make decisions or make decisions for you.
8. To talk with providers in confidence and to have your health care information and
records kept confidential.
9. To see and get a copy of your medical records and to ask for changes or
corrections to your records.
10. To ask for a second opinion.
11. To file a Grievance if you disagree with Highmark Wholecare’s decision that a service
is not medically necessary for you.
12. To file a Complaint if you are unhappy about the care or treatment you have
13. To ask for a DHS Fair Hearing.
14. To be free from any form of restraint or seclusion used to force you to do
something, to discipline you, to make it easier for the provider, or to punish you.
15. To get information about services that Highmark Wholecare or a provider does not
cover because of moral or religious objections and about how to get those
16. To exercise your rights without it negatively affecting the way DHS, Highmark Wholecare, and network providers treat you.
17. To create an advance directive. See Section 6 on page 70 of the Member Handbook
for more information.
18. To make recommendations about the rights and responsibilities of Highmark Wholecare’s members.
Members need to work with their health care service providers. Highmark Wholecare needs your help so that you get the services and supports you need.
These are the things you should do:
1. Provide, to the extent you can, information needed by your providers.
2. Follow instructions and guidelines given by your providers.
3. Be involved in decisions about your health care and treatment.
4. Work with your providers to create and carry out your treatment plans.
5. Tell your providers what you want and need.
6. Learn about Highmark Wholecare coverage, including all covered and non-covered
benefits and limits.
7. Use only network providers unless Highmark Wholecare approves an out-of-network
provider or you have Medicare.
8. Get a referral from your PCP to see certain specialists.
9. Respect other patients, provider staff, and provider workers.
10.Make a good-faith effort to pay your co-payments.
11.Report fraud and abuse to the DHS Fraud and Abuse Reporting Hotline.