Member rights and responsibilities 

Your rights

As a member of Highmark Health Options, you have rights around your health care.

You have the right to: 

  • Ask for and obtain all included information. 
  • Be told about your rights and responsibilities. 
  • Get information about Highmark Health Options, our services, our providers, and your rights. 
  • Be treated with respect and dignity. 
  • Not be discriminated against by Highmark Health Options. 
  • Access all services that Highmark Health Options must provide. 
  • Choose a provider in our network. 
  • Take part in decisions about your health care. 
  • Refuse treatment and choose a different provider. 
  • Get information on treatment options and different courses of care. 
  • Have your privacy respected. 
  • Ask for and get your medical records. 
  • Ask that your medical records be changed or corrected if needed. 
  • Be sure your medical records will be kept private. 
  • Recommend changes in policies and procedures. 
  • Be free from any form of restraint or seclusion used as a means of force, discipline, convenience, or retaliation. 
  • Get covered services, no matter your cultural or ethnic background or how well you understand English. 
  • Get covered services regardless of if you have a physical or mental disability, or if you are homeless. 
  • Refer yourself to in-network and out-of-network family planning providers. 
  • Access certified nurse midwife services and certified pediatric or family nurse practitioner services. 
  • Get emergency post-stabilization services. 
  • Get emergency health care services at any hospital or other setting. 
  • Accept or refuse medical or surgical treatment and to make an advance directive. 
  • Have your parent or a representative make treatment decisions when you can’t. 
  • Make complaints and appeals. 
  • Get a quick response to problems raised around complaints, grievances, appeals, authorization, coverage, and payment of services. 
  • Ask for a state fair hearing after a decision has been made about your appeal. 
  • Request and get a copy of your Member Handbook. 
  • Disenroll from your health plan.

Your responsibilities

As a member of Highmark Health Options, you also have some responsibilities: 

  • Read through and follow the instructions in your Member Handbook. 
  • Work with your PCP to manage and improve your health. 
  • Ask your PCP any questions you may have. 
  • Call your PCP at any time when you need health care. 
  • Give information about your health to Highmark Health Options and your PCP. 
  • Always remember to carry your member ID card. 
  • Only use the ER for true emergencies. 
  • Keep your appointments. 
  • If you must cancel an appointment, call your PCP as soon as you can to let him or her know. 
  • Follow your PCP’s recommendations about appointments and medicine. 
  • Go back to your PCP or ask for a second opinion if you do not get better. 
  • Call Member Services at 1-833-957-0020 (TTY: 711) whenever anything is unclear to you or you have questions. 
  • Treat health care staff and others with respect. 

We’re here for you

  • Call Member Services at1-833-957-0020 (TTY: 711), Monday–Friday, 8 a.m.–5 p.m.
  • Para asistencia en español llame al1-833-957-0020. 
  • For language interpretation services, call 1-833-957-0020.
  • If you’re having a medical emergency, call 911. 
  • If you're having a mental health emergency, call 988.