As a consumer, you have the right to:
- expect that any medical records and personal health information have been treated as confidential and protected.
- receive information regarding the Utilization Management determination, including the clinical rationale and clinical criteria used to make the determination.
- be informed of appeal procedures, timelines, and instructions about how to request an appeal.
- request information about how to file a complaint, file a complaint, and receive timely resolution or a referral of the complaint to another entity.
As a consumer, you have the responsibility to:
- provide the most accurate and complete information to your healthcare provider regarding your clinical history.
- be familiar with state laws and how they affect your workers’ compensation claim.