Patient’s Rights & Responsibilities

Case Management participants have the right to:

I. Information Disclosure

  • Receive in a timely manner, a description of the case management program, and fully understand its benefits and interventions.
  • To be informed about the reason they are selected for case management and criteria for discontinuation of case management.
  • Receive quality, cost-effective, health care coordination at no cost to the consumer.
  • To be notified if case management services are changed or discontinued and the rationale for change or discontinuation.
  • Know the hours of operation for Critique are 8:00 AM to 5:00 PM (MT II. Informed Choices
  • Be informed about options for services or health care alternatives Choose health care providers and make decisions regarding their health care.
  • Refuse treatment or case management services and understand the implication of such refusal related to insurance benefits and/or health outcomes.

II. Participation in Treatment Decisions

  • Contribute to the case management plan.
  • Be eligible for case management when the consumer and/or family are not fully able to participate in the assessment phase through use of alternative approaches, such as communication through a family member, etc.

III. Expect Respect and Nondiscrimination

  • Receive respectful, considerate case management services.
  • Be respected by Critique regarding the use of end-of-life and advanced care directives.
  • Receive case management services without discrimination as to race, color, religion, sex, national origin, disability or sexual orientation.

IV. Confidentiality of Health

  • Information Expect all records and communication pertaining to the consumer’s health care be kept confidential as directed by privacy laws.

V. Grievances

  • A fair, fast, and objective review of any grievance or suggestion for change to the case management service or staff without fear of reprisals or discrimination by calling customer service at 1-888-272-4002, option 2; or mailing a written notification of grievance to: Director of Nursing, P.O. Box 571123, Salt Lake City, UT 84157-1123.

Case Management participants have the responsibility to:

 

1. Provide information that is accurate and complete concerning present complaints, current treatment plan, past medical history and other matters related to their health.
2. Return the case manager’s phone calls in a timely manner.
3. Inform the case manager whether they understand the information the case manager presents to them.
4. Be educated about their condition and needs.
5. Be respectful and considerate to the case manager.
6. Comply with the treatment plan.
7. Communicate end-of-life or advanced care directives with the case manager and providers.
8. Inform the case manager of changes in treatment plan or health care, as well as changes in health care providers.
9. Notify the case manager of changes in health insurance coverage or eligibility.
10. Notify the case manager if eligible for benefits under another plan.
11.Verify benefits and eligibility with their Third Party Administrator or Insurance Company.
12. Evaluate the case manager’s services at the end of service.

 

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