Your Rights as a Member

As an Independent Health’s Pharmacy Benefit Dimensions LLC (“PBD”) member, you are entitled to certain rights and responsibilities that we want to make sure are being met. Here is a summary of your member rights and responsibilities:

• A right to receive information about the organization, its services, its practitioners and providers and member rights and responsibilities.
• A right to be treated with respect and recognition of your dignity and your right to privacy.
• A right to participate with practitioners in making decisions about your health care.
• A right to a candid discussion of appropriate or medically necessary treatment options for your condition(s), regardless of cost or benefit coverage.
• A right to voice complaints or appeals about the organization or the care it provides.
• A right to make recommendations regarding the organization’s member rights and responsibilities policies.
• A responsibility to supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
• A responsibility to follow plans and instructions for care that you have agreed to with your practitioners.
• A responsibility to understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.

Privacy and Confidentiality

As new and potential laws regarding the privacy and confidentiality of health information are reviewed in the state and federal government, it is important for you to know that PBD is committed to maintaining the confidentiality of your health information.

• When you, as a subscriber, enroll with PBD, you give a general consent for your own medical records and those of your family members to be accessed by PBD as provided under the terms of your member contract.
• PBD’s contracts with participating providers reinforce your right under New York State law to access your own medical records although your provider may charge a per page copying fee.
• You have the right to the protection of privacy of your health information in all settings, including privacy and confidentiality of all records pertaining to treatment unless otherwise provided by law or by your member contract.
• All member information and records used for purposes of preparing, compiling, or analyzing PBD measurement data shall be kept confidential. All member-specific information shall be removed from such measurement data prior release, except in circumstances when state or federal regulatory agencies request "patient level" data as allowed by law.
• Except under the terms of the member contract, PBD will not release a member’s identifiable medical records to any third party, including the member’s fully insured employer, without receiving a signed special release from the member.

Confidentiality for Victims of Domestic Violence and Endangered Individuals

As a member of PBD, you have the right to request how PBD communicates with you to prevent a dangerous situation to yourself or others. To learn more, read the Confidentiality Protocol.

Drug Formulary

A drug formulary is a list of the most appropriate and cost-effective medications from which participating physicians prescribe.

If you have any questions or would like a copy of our Privacy and Confidentiality notice or Drug Formulary, please call our Member Services department at 1-888-878-9172. TTY users call: 711.

 

Rev 7/24.

OA-6432-5041 CMS File #MR-004, 11/2004