Member Rights - Community Health Plan of Washington - Medicare Advantage

Member Rights

As a CHPW Medicare Advantage member, you have rights.

Member Rights

We protect your health information, and you have the right to know how.

Our Medicare Notice of Privacy Practices tells you how we use and share your information. It also includes your health privacy rights. We suggest you review your Member Rights and Responsibilities to help ensure you get the best care.

Know Your Rights and Protected Health Information

Your protected health information (PHI) is protected by federal law. Your PHI includes information such as your name, member number, or other identifying information.

You have the legal right to:

  • Ask us for access to your PHI
  • Ask us to correct your PHI
  • Ask for a list of certain people and times we shared your PHI
  • Ask for certain restrictions about how we share your PHI
  • Ask us to change your contact information

Please see “Forms for Medicare Members” below for information on how to submit a request.

Use, Disclosure, and Security of Protected Health Information:

Community Health Plan of Washington (CHPW) is committed to keeping your PHI safe. Below are some ways CHPW protects PHI:

  • We use technology to protect your PHI
  • Our office is physically secure
  • We control access to our office with security access procedures and all people who enter our facility must wear identification
  • CHPW trains staff to protect the privacy and security of PHI
  • We limit who may see PHI. Only staff with a need to know PHI may use it.
  • We limit what we discuss on the phone
  • We keep written health information locked in a drawer when not in use
  • We keep our computers secured at all times
  • We send health information by email in a form that cannot be read if somebody else sees the email

If your health information is ever shared with someone who should not see it, or who is not required to protect it under the law, we take steps to correct the mistake by notifying you and the appropriate government agencies.

Fraud, Waste, & Abuse

CHPW is committed to doing all we can to prevent, detect, and correct health care fraud. Report a situation that may be potential health care fraud. When you report a situation that may be potential health care fraud, you’re doing your part to help save money for the health care system. Learn about the warning signs and what to look out for. If you suspect fraud, waste or abuse, you can report to us online, anonymously.

➔ Read more about reporting potential health care fraud.

Advance Directive

An advance directive puts your choices for health care into writing and tells your doctor and family what kind of care you do or do not want. Having an advance directive means your loved ones or your doctor can make medical choices for you based on your wishes.

➔ Learn how to create an advance directive for your health care preferences.

Grievances & Appeals

We take your concerns seriously. You can file a grievance with your health care plan if you are not happy with the way you were treated, the quality of care or services you received, you have problems getting care, treatment or medication you need is denied, or you have billing issues.

➔ Learn how to submit a grievance (complaint) or an appeal.

Second Opinion

A second opinion is a recommendation from a doctor other than your current doctor. A second opinion can confirm or question the first doctor’s diagnosis and treatment plan. This can give you more information about the disease or alternative treatment options available. At any time you can get a second opinion about your health care or condition. Call Customer Service at 1-800-440-1561 to find out how to get a second opinion.

Forms for Medicare Members

Use the following forms to update your information and authorize who can access your Protected Health Information.

To request your health information, complete the appropriate form and send it to:

Community Health Plan of  Washington
Attn: Compliance, Privacy, and Security Officer
1111 Third Ave., Suite 400
Seattle, WA 98101

Your Rights Upon Disenrollment

Your plan’s Evidence of Coverage document includes information on member’s and plan’s rights and responsibilities upon disenrolling in plan coverage.

You may only disenroll during qualifying election periods such as the Annual Election Period (October 15 – December 7), or if you qualify for a Special Election period (SEP). The Medicare Advantage Dis-enrollment Period (MADP), from January 1 to February 14th allows you to return to Original Medicare. You would then be eligible for a SEP and may request enrollment in a PDP.

Review the Member Rights Upon Disenrollment policy to learn more about your rights and responsibilities.

Contact Us

If you believe your privacy rights have been violated, you may file a complaint with us by phone or mail. We will not penalize you in any way if you file a complaint.  We can also assist you with any questions about the privacy and security of your PHI.

Phone
Current members: 1-800-942-0247 (TTY Relay: Dial 711)
from 8:00 a.m. to 8:00 p.m., seven days a week.

Mail
Community Health Plan of Washington
Attn: Compliance, Privacy, and Security Officer
1111 Third Ave., Suite 400
Seattle, WA 98101

DID YOU KNOW...?

Dental Coverage

Keeping your teeth and gums healthy is an important part of your whole health care plan. Dental coverage is included on select plans for yearly cleanings, x-rays, fluoride treatments, and other limited services.

LEARN MORE

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Email: Sales@chpw.org

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