Member Rights and Responsibilities

• Ask questions and make sure you understand the answers.
• Choose a doctor with whom you feel comfortable talking.
• Be treated with respect for your privacy and dignity.
• Take a relative or friend with you to help you ask questions and understand answers.
• Have any person who has legal responsibility to make medical care decisions for you make use of these rights on your behalf.
• Receive interpretive services, as necessary, when discussing your care or treatment plan.
• Provide complete and accurate information to the best of your ability.
• Inform the provider about any living will, medical power of attorney or other directive that could affect care.
• Treat all health care providers respectfully.
• Follow the treatment plan prescribed by your health care provider.
• Request information regarding malpractice insurance of providers.
• Get up-to-date credentials for the services covered or not covered by your plan, and any limitations or exclusions.
• Know how your plan decides what services are covered.
• Get information about co-payments and fees that you must pay.
• Get up-to-date information about the health care professionals, hospitals and other providers that participate in the plan.
• Be told how to file a complaint or appeal with the plan.
• Know how the plan pays both in-network and out-of-network health care professionals for providing services to you.
• Receive information from health care professionals about your medications, including what the medications are, how to take them and possible side effects.
• Receive from health care professionals as much information about their diagnosis, evaluation, prognosis and any proposed treatment or procedure as you may need in order to consent to or refuse a course of treatment. Except in an emergency, this information should include a description of the proposed procedure or treatment, the potential risks and benefits involved, any alternate course of treatment (even if not covered) or non-treatment and the risks involved in each, and the name of the health care professional who will carry out the procedure or treatment.
• Be informed by participating health care professionals about continuing health care requirements after you are discharged from inpatient or outpatient facilities.
• Be informed if a health care professional plans to use an experimental treatment or procedure in your care. You have the right to refuse to participate in research projects.
• Receive an explanation about non-covered services.
• Request interpretive services when necessary
• Receive a prompt reply when you ask the plan questions or request information.
• Receive a copy of the plan’s Member Rights and Responsibilities Statement.

• Visit the Find a Provider Tool at www.fsbphealth.com to look up providers who are in the network or call 202-833-4910 and we will help you find a participating provider near your home or office.
• Provider information can change. Call your doctor before your appointment to confirm network status.
• Change your doctor (primary care or specialist) to another available doctor or one who participates in the plan at any time.
• Confirm your provider is in network to obtain in-network benefits as you will be responsible for any additional costs when accessing an out-of-network provider.
• If you have an emergency, call 911 immediately and go to the nearest emergency facility to when you have a medical condition with acute symptoms. When there is an emergency admission you, your representative, the doctor, or the hospital must call 1-800-593-2354 (TTY: 711) within two business days after the day of admission, even if you have been discharged from the hospital.
• If you have a non-life-threatening situation but need immediate medical care, you can receive treatment at an Urgent Care Center or Convenient Care Clinic at a lower cost.

• Bring the actual medicines or give your doctor and pharmacist a list of all the medicines and dosage that you take, including non-prescription (over-the-counter) medicines and nutritional supplements.
• Tell your doctor and pharmacist about any drug, food, and other allergies you have, such as latex.
• Ask about any risks or side effects of the medication and what to avoid while taking it. Be sure to write down what your doctor or pharmacist says.
• Make sure your medicine is what the doctor ordered. Ask the pharmacist about your medicine if it looks different than you expected.
• Read the label and patient package insert when you get your medicine, including all warnings and instructions.
• Know how to use your medicine. Especially note the times and conditions when your medicine should and should not be taken.
• Contact your doctor or pharmacist if you have any questions.
• Understand both the generic and brand names of your medication. This helps ensure you don’t receive double dosing from taking both a generic and a brand. It also helps prevent you from taking a medication to which you are allergic.

• Ask when and how you will get the results of tests or procedures. Will it be in person, by phone, mail, or through the Provider’s portal?
• Don’t assume the results are fine if you do not get them when expected. Contact your health care provider and ask for the results.
• Ask what the results mean for your care.
• Be informed if a health care professional plans to use an experimental treatment or procedure in your care. You have the right to refuse to participate in research projects.

• Ask your doctor about which hospital has the best care and results for your condition if you have more than one hospital to choose from to get the health care you need.
• Be sure you understand the instructions you get about follow-up care when you leave the hospital or clinic.

• Make sure you, your doctor, and your surgeon all agree on exactly what will be done during the operation.
• Ask your doctor, “Who will manage my care when I am in the hospital?”
• Ask your surgeon
  “Exactly what will you be doing?”
  “About how long will it take?”
  “What will happen after surgery?”
  “How can I expect to feel during recovery?”

Tell the surgeon, anesthesiologist, and nurses about any allergies, bad reactions to anesthesia, and any medications or nutritional supplements you are taking.

• http://www.jointcommission.org/speakup.aspx. The Joint Commission’s Speak Up™ patient safety program.
• http://www.jointcommission.org/topics/patient_safety.aspx. The Joint Commission helps health care organizations to improve the quality and safety of the care they deliver
• www.ahrq.gov/consumer/. The Agency for Healthcare Research and Quality makes available a wide-ranging list of topics not only to inform consumers about patient safety but to help choose quality health care providers and improve the quality of care you receive.
• www.npsf.org. The National Patient Safety Foundation has information on how to ensure safer health care for you and your family.
• www.talkaboutrx.org. The National Council on Patient Information and Education is dedicated to improving communication about the safe, appropriate use of medicines.
• www.leapfroggroup.org. The Leapfrog Group is active in promoting safe practices in hospital care.
• www.ahqa.org. The American Health Quality Association represents organizations and health care professionals working to improve patient safety.

When you enter the hospital for treatment of one medical problem, you don’t expect to leave with additional injuries, infections, or other serious conditions that occur during the course of your stay. Although some of these complications may not be avoidable, patients do suffer from injuries or illnesses that could have been prevented if doctors or the hospital had taken proper precautions. Errors in medical care that are clearly identifiable, preventable and serious in their consequences for patients, can indicate a significant problem in the safety and credibility of a health care facility. These conditions and errors are sometimes called “Never Events” or “Serious Reportable Events.”

We have a benefit payment policy that encourages hospitals to reduce the likelihood of hospital-acquired conditions such as certain infections, severe bedsores, and fractures, and to reduce medical errors that should never happen. When such an event occurs, neither you nor your FEHB plan will incur costs to correct the medical error.

You will not be billed for inpatient services related to treatment of specific hospital acquired conditions or for inpatient services needed to correct Never Events, if you use Foreign Service Benefit Plan in-network providers. This policy helps to protect you from preventable medical errors and improve the quality of care you receive.

1620 L Street, NW, Suite 800 Washington, DC 20036-5629 1-202-833-4910
Website: www.AFSPA.org/FSBP E-Mail: health@AFSPA.org Fax: 1-202-833-4918

07/2022