Members of HMOs and POS plans, or any health plan that manages the use of services through provider networks, have important consumer rights including:

• The right to have a doctor - not an administrator - make the decision to deny or limit coverage
• The right to appeal a decision to deny or limit coverage, first within the managed care plan, then through an independent organization for a $25 filing fee (reduced to $2 for hardship) See page 20 for details.
• The right to no "gag rules." Doctors are allowed to discuss all treatment options even if they are not covered services.
• The right to receive up to 120 days of continued coverage - if medically necessary - from a doctor who has been terminated by a managed care plan
• The right to know how your managed care plan pays its doctors so you know if financial incentives or disincentives are tied to medical decisions
• The right to obtain a current directory of doctors within the network
• The right to have a choice of specialists following a referral
• The right of consumers with chronic disabilities to be referred to specialists who are experienced treating those disabilities
• The right to access a primary care provider or a back-up 24 hours a day, 365 days a year for urgent care
• The right to call 911 in a potentially life-threatening situation without prior approval from your managed care plan
• The right to have a plan pay for a medical screening exam in the emergency room to determine whether an emergency medical condition exists
• The right to no retaliation against you or your doctor for filing appeals