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Member’s information, including prescription drug event data, to Medicare, which may release it for
research and other purposes that follow all applicable Federal statutes and regulations.
The right to see Participating Providers, get covered services, and get prescriptions filled within a
reasonable period of time
Members will get most or all of their health care from Participating Providers, that is, from doctors and
other health Providers who are part of Bravo Health. Members have the right to choose a Participating
Provider (Bravo Health will tell Members which doctors are accepting new patients). Members have
the right to go to a women’s health specialist (such as a gynecologist) without a referral. Members
have the right to timely access to their Providers and to see specialists when care from a specialist is
needed. Members also have the right to timely access to their prescriptions at any network pharmacy.
“Timely access” means that Members can get appointments and services within a reasonable amount
of time. The Evidence of Coverage explains how Members access Participating Providers to get the
care and services they need. It also explains their rights to get care for a medical emergency and
urgently needed care.
The right to know treatment choices and participate in decisions about their health care
Members have the right to get full information from their Providers when they go for medical care,
and the right to participate fully in treatment planning and decisions about their health care. Bravo
Health Providers must explain things in a way that Members can understand. Members have the right
to know about all of the treatment choices that are recommended for their condition including all
appropriate and medically necessary treatment options, no matter what they cost or whether they are
covered by Bravo Health. This includes the right to know about the different Medication Management
Treatment Programs Bravo Health offers and in which Members may participate. Members have the
right to be told about any risks involved in their care. Members must be told in advance if any
proposed medical care or treatment is part of a research experiment, and be given the choice of
refusing experimental treatments.
Members have the right to receive a detailed explanation from Bravo Health if they believe that a plan
Provider has denied care that they believe they are entitled to receive or care they believe they should
continue to receive. In these cases, Members must request an initial decision. “Initial decisions” are
discussed in the Members’ Evidence of Coverage.
Members have the right to refuse treatment. This includes the right to leave a hospital or other medical
facility, even if their doctor advises them not to leave. This includes the right to stop taking their
medication. If Members refuse treatment, they accept responsibility for what happens as a result of
refusing treatment.
The right to use advance directives (such as a living will or a power of attorney)
Members have the right to ask someone such as a family member or friend to help them with decisions
about their health care. Sometimes, people become unable to make health care decisions for
themselves due to accidents or serious illness. If a Member wants to, he/she can use a special form to
give someone they trust the legal authority to make decisions for them if they ever become unable to
make decisions for themselves. Members also have the right to give their doctors written instructions
about how they want them to handle their medical care if they become unable to make decisions for
themselves. The legal documents that Members can use to give their directions in advance in these
situations are called “advance directives.” There are different types of advance directives and
different names for them. Documents called “living will” and “power of attorney for health care”
are examples of advance directives.
