For Your Protection
You have the right to:
- Be treated with respect and in a dignified way.
- Get written information from your Insurer in English and Spanish and translated into any other language. You also have the right to get written information in an alternative format. Afterwards, you have the right to get all future written information in that same format or language, unless you tell your Insurer otherwise.
- Get information about your Insurer, health care facilities, health care professionals, health services covered, and how to access services.
- Choose a Primary Medical Group, your PCP, and other doctors and providers within your Preferred Provider Network.
- Choose a dentist and a pharmacy among your Insurer’s network.
- Contact your doctors when you want to and in private
- Get medically necessary care that is right for you, when you need it. This includes getting emergency services, 24 hours a day, 7 days a week.
- Be told in an easy-to-understand way about your care and all of the different kinds of treatment that could work for you, no matter what they cost or even if they aren’t covered.
- Help to make decisions about your health care. You can turn down care.
- Ask for a second opinion for a diagnosis or treatment plan.
- Make an Advanced Directive. Look at Part 6 of this guide for more information.
- Get care without fear of physical restraint or seclusion used for bullying, discipline, convenience or revenge.
- Ask for and get information about your medical records as the federal and state laws say. You can see your medical records, get copies of your medical records, and ask to correct your medical records if they are wrong.
- File a complaint or an appeal about your Insurer or your care. Look at Part 6 of this guide for more information. The complaint can be filed in your Insurer’s office or in the Patience Advocate office.
- Get services without being treated in a different way because of race, color, birthplace, language, sex, age, religion, or disability. You have a right to file a complaint if you think you have been treated unfairly. If you complain or appeal, you have the right to keep getting care without fear of bad treatment from your Insurer, providers, or Vital.
- Choose an Authorized Representative to be involved in making decisions.
- Provide informed consent.
- Only have to pay the amounts for services listed in Part 4 of this guide. You can’t be charged more than those amounts.
- Be free from harassment by your Insurer or its Network Providers with respect to contractual disputes between the Insurer and its Providers;
YOUR RIGHT TO PRIVACY (HIPAA)
Your health information is private. The law says that ASES and your Insurer must protect your information. ASES and your Insurer can share your information for your care, to pay your health claims, and to run the program. But we can’t share your information with others unless you tell us we can. If you want to know more about what information we have, how we can share it, or what to do if you don’t want your health information shared with certain people, call your Insurer.
You have the responsibility to:
- Understand the information in your guide and other papers that your Insurer sends you.
- Give your doctor your health records and let them know about any changes in your health so that they can take care of you.
- Follow your doctor’s instructions. If you can’t follow your doctor’s instructions, let them know.
- Let your doctor know if you don’t understand something.
- Help to make decisions about your health care.
- Communicate your Advance Directive so your doctors know how you want to be treated if you are too sick to say so.
- Treat your health care provider and your Insurer’s staff with respect and dignity.
- Let your Insurer know if you have another insurance company that should pay your medical care.
- Let ASES know if you find out about a case of fraud and abuse in Vital.
Advance Directives are your written wishes about what you want to happen, if you get too sick to be able to say. The written document that states your Advance Directives is called a living will. You can use either word: advance directive or living will.
Your doctor can give you information on how to make an Advance Directive. If you are in the hospital, the hospital staff can also give you information on Advance Directives. You can also call the Senior Citizens Advocate Office at 787-721-6121. They have free information about Advanced Directives.
A Durable Power of Attorney is a paper that lets you name another person to make medical decisions for you. This person can only make decisions if you are too sick to make your own. He or she can say your wishes for you if you can’t speak for yourself. Your illness can be temporary.
You do not have to fill out these papers for an Advance Directive or Durable Power of Attorney. It is your choice. You may want to talk to a lawyer or friend before you fill out these papers.
To make all of these papers legal, you need to have a lawyer watch you sign the form. Instead of a lawyer, you could also have your doctor plus two additional witnesses watch you sign the form. The two additional witnesses have to be of legal age and they can’t be related to you by blood or marriage.
Once the papers are signed by everyone, it is your rule about what you want to happen to you if you get too sick to be able to say. It stays like this unless you change your mind.
These papers will only be used if you get too sick to be able to say what you want to happen. As long as you can still think for yourself, you can decide about your health care yourself.
Give a copy of the papers to your PCP and to your family members so they know what you want to happen to you if you are too sick to say.
If you feel that your Insurer or your doctors aren’t complying with your wishes, or if you have any complaints, you have the right to call the Vital call center at 1-800-981-2737 or the Puerto Rico Patient Advocate Office at 1-800-981-0031. The phone call is free.