Virginia Premier Health Plan, Inc.

Member Rights

It is the policy of Virginia Premier Health Plan, Inc. (VPHP) to treat all members with respect.  The organization remains dedicated in keeping members educated and informed of their rights and responsibilities while maintaining a high level of confidentiality with due consideration for dignity and privacy.

• Timely access to your PCP and referrals to specialists when medically necessary and timely access to all covered services, both clinical and non-clinical.
• Treatments with quality care, respect, dignity and right to privacy.
• Have healthcare services twenty-four (24) hours a day, three hundred and sixty-five (365) days a year, including urgent, emergency and post stabilization services.
• Choose your personal VPHP doctor/Primary Care Physician (PCP).
• Change your personal VPHP doctor and choose another one from VPHP’s Provider Directory (included in the enrollment/membership package).
• Make your own doctor/PCP appointments to be seen in their private office at your convenience.
• Not to be treated against your will.
• Ask your doctor/PCP questions. Do not be afraid.
• Call Member Services to file a complaint/grievance about VPHP or file an appeal if you are not happy with the answer to your inquiry (question), complaint/grievance, or care given.
• Have you and/or your child’s medical records kept private unless you sign a permission form.
• Have timely access to your medical records in accordance with applicable State and Federal laws.  You may be required to sign for release of those records.
• Participate with your physician in making decisions about your health care, give your consent for all care, and make decisions to accept or refuse medical care to the extent permitted by law and be made aware of the medical consequences of such action.
• Have your doctor tell you about all treatment options and alternatives, presented in a manner that can be easily understood, regardless of the cost or benefit coverage. You can also receive a second opinion from VPHP’s network of providers.
• Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in Federal regulations on the use of restraints and seclusion.
• Free exercise of rights regardless of your race, physical or mental ability, ethnicity, gender, sexual orientation, creed, age, religion or your national origin, cultural or educational background, economic or health status, English proficiency, reading skills or source of payment for your care.
• Receive information about VPHP, its services, providers and Members’ Rights and Responsibilities.
• To know the names and qualifications of the physicians and health care professionals involved in your medical treatment.
• Make suggestions regarding VPHP’s Member Rights and Responsibilities statement, which is found in the member handbook.
• Use Advanced Directives (such as a Living Will or a Power of Attorney).
• See an in network doctor in a timely manner based on the access standards as listed on page 57 of the member handbook.
• Get emergency care and family planning services in or out of network without prior authorization. Family planning services, preventive services, and basic prenatal care do not need preauthorization, but you should get care from an in network doctor/provider.
• Not have VPHP stop or limit a doctor/provider acting within the lawful scope of practice, from telling or helping on behalf of a member who is his or her patient, related to the member’s health condition, medical care or treatment choices, including any other treatment that may be self-administered.
• Have the doctor write in his or her medical record whether or not the member has completed an advance directive. 
• Not have the doctor/provider condition the delivery of care or discriminate against a member based on whether he/she has completed an advance directive form.
• Contact VPHP staff that has been trained on advance directives and asks questions, if needed.
• File any type of grievance, including those related to advance directives, with VPHP by calling the toll free line at 1-800-727-7536, the Department of Medical Assistance Services, the Bureau of Insurance and the Department of Health.
• Give female members direct access (no referral needed) to a woman’s health doctor/provider in the network for covered routine and preventive care services.  This is in addition to the member’s assigned primary care doctor/provider if that person is not a women’s health doctor/provider. 
• Have his/her health care needs and information discussed and given to the doctors/providers they want.  The member can call Member Services and ask that VPHP have the information sent to their doctor.
• Confidentiality when managing care including medical records, member information and appointment records for the treatment of sexually transmitted diseases.
• Not be responsible for the bill or extra costs, if out of network services are given to a member for emergency care or care that has been preauthorized.
• See in network doctors/providers with office hours that are the same as those for other patients who may not have Medicaid like private commercial insurance members and or other types of Medicaid members (fee for service), if the doctor/provider sees only Medicaid members.
• See a doctor of his/her choice based on language and/or race and one who is sensitive to the member’s cultural needs, including those who cannot speak English good and those with different cultural and racial backgrounds.
• Get information in different formats (i.e., large print, Braille, etc), if needed and in an easy form that takes into consideration the special needs of those who may have problems seeing or reading.
• Have any service that has been stopped start again, if a member’s location is known.
• VPHP will provide information to members about advance directives and any changes made in state law as soon as possible but no later than 90 days after the effective date of change.