Treat all Members with respect and courtesy, as you would want yourself or your loved ones to be treated.
Respond promptly to Members’ questions and document communications with Members as appropriate.
Protect the rights of Members by publicizing such rights to Members, Community employees, and network Providers.
Comply with all the legal and professional standards of care, ethics, conduct and behavior applicable to health maintenance organizations, their employees, and their network Providers.
Provide all Members with information concerning the benefits available to them so that they may avail themselves of such benefits as appropriate.
Ensure that Members have reasonable access to the services to which they are entitled under their health plan.
Assist Members (or their legal guardians, when appropriate) with making informed decisions about their medical care, including providing them with information about withholding resuscitative services, foregoing or withdrawing life-sustaining treatment, or participating in studies or clinical trials. Providers, as required by law, shall obtain informed consent.
Preserve the integrity and independence of clinical decision-making by individual Providers in the Community Provider Network. In making clinical decisions concerning a Member’s medical care, a Community Network Provider shall not allow himself/herself to be influenced by how the Provider or Provider network is financially compensated or by whether a particular treatment or course of care would be covered by the Member’s plan. In conveying information concerning whether a particular treatment is covered by a Member’s plan, no Community employee shall attempt to influence the Provider’s clinical decision with respect to the Member’s need for such treatment.
Avoid conflicts of interest. Network Providers making clinical decisions concerning a