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Our Mission, Values and Commitment
Mission
Build a family of companies that meets the needs of our policyholders,
customers and communities.
Vision
The Company is strong, vibrant and fully able to compete in a changing
business climate.
Values
Best Service
Our policyholders, members, brokers, benefit consultants and group benefit
managers are our customers. We recognize that each employee who has direct contact with our
customers is our key internal client and will receive prompt and adequate support from the
entire organization to meet our customers' needs. We will maintain and build upon our tradition
of fast, accurate claims payment and excellent customer service. We will design and manage the
customer health benefits, healthcare provider relationships and management systems so as to
facilitate and support quality, efficient and effective healthcare.
Best Products
We are committed to producing superior value for our members by assuring
access to quality healthcare providers who offer appropriate care at an affordable price.
We are committed to maintaining and building our volume of sales to accommodate risk and
spread overhead expense. We will protect our policyholders by operating efficiently and
profitably, thereby assuring adequate and well-managed financial reserves for future claims.
Responsible Citizen
We will set an example as an excellent community and corporate citizen.
Our relationships and interactions with our customers, employees, healthcare providers,
governmental agencies and competitors will exhibit the highest professional standard of
conduct. We will actively support and participate in organizations that serve to strengthen
and improve the health and well being of the communities we serve.
Employee Development
We recognize that our employees are our most important asset in meeting
the needs of our customers. We will foster a workplace environment that recognizes, rewards
and empowers employees for excellence in service, quality and continuous improvement. We
will provide opportunities for personal and professional development and growth of our employees.
Providing Coverage at a Reasonable Cost
We understand the importance of affordable healthcare in today's world
and, as such, we will strive to keep control of healthcare costs through efficient management
of the partnerships we share with the physicians and hospitals in our network. We are
committed to providing outstanding value for all customers throughout our family of companies.
Commitment
Cooperate with their healthcare practitioners in following the prescribed
care plan to which they have agreed.
Understand their health problems and participate in developing mutually
agreed upon treatment goals to the degree possible.
Promptly pay appropriate copayments, coinsurance, and deductibles. Provide
to Medical Mutual and to healthcare practitioners the information needed to provide proper
care and to appropriately administer claims, payment, and coordination with other payers.
Choose a primary care physician to coordinate medical services if
required by their insurance plan.
Bill of Rights
Medical Mutual Members have the right to:
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Choose among quality healthcare practitioners, hospitals, pharmacies and other facilities within a network and get covered services
and prescriptions filled (if applicable) within a reasonable period of time. Women have the right to see a women’s health
specialist without a referral.
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Emergency medical care as defined by a prudent layperson.
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Information about their healthcare practitioners, benefits, financial liability, health promotion, illness prevention, advance directives and treatment options regardless of cost or benefit coverage, in a language they understand.
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Prompt, courteous and respectful care and service by Medical Mutual’s employees in a culturally sensitive way and not be discriminated against based on race, ethnicity, national origin, religion, sex, age and mental or physical disability.
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Privacy and confidentiality in the use of their personal and medical information and records and the option to request confidential communications.
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Request and receive a copy of their protected health information and to amend their protected health information for corrections and/or omissions.
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Request an accounting of protected health information disclosures outside of routine uses, complain about privacy violations, and receive a Notice of Privacy Practices.
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Authorize or deny release of personal health information beyond use for treatment, payment or healthcare operations.
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Exercise all federal and state rights, including rights under the Health Information Portability and Accountability Act (HIPAA), without fear of retaliation or condition of payment. Members will not be required to waive their rights in order to be provided benefits.
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Be informed and responsible participants with practitioners in decisions affecting their health and/or have a representative facilitate healthcare when they are unable to do so.
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Refuse medical treatment.
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Prompt, accurate payment of their claims in accordance with the terms of their policies.
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Communicate complaints to Medical Mutual and receive instructions on how to use the complaint process. Know Medical Mutual’s standards of timeliness for responding to and resolving issues of quality complaints or grievances, which may arise in the course of purchasing and utilizing our insurance plans and services.
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Appeal adverse benefit determinations.
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If covered by an insured program, request a review by the department of insurance or other independent review entity as appropriate if Medical Mutual denies, reduces or discontinues coverage for a healthcare service because the Company determines that the service was not covered as part of the health plan or not medically necessary.
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Ask and be informed about business relationships between Medical Mutual and the practitioners, hospitals and other healthcare professionals and facilities that may influence members’ treatment and care.
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Have information about Medical Mutual including programs and services provided to eligible individuals on behalf of the employer or plan sponsors, its staff and its staff’s qualifications and any contractual relationships.
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Decline participation or disenroll from programs and services offered by Medical Mutual.
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Access a full range of care and receive the right care at the right time and place.
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Make recommendations regarding the members’ rights and responsibilities policies.
Medical Mutual Members have the responsibility to:
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Cooperate with their healthcare practitioners in following the prescribed care
plan to which they have agreed.
-
Understand their health problems and participate in developing mutually agreed
upon treatment goals to the degree possible.
-
Promptly pay appropriate co-payments, coinsurance, and deductibles.
-
Provide to Medical Mutual and to healthcare practitioners the information needed to provide proper care and to appropriately administer claims, payment, and coordination with other payers.
-
Choose a primary care physician to coordinate medical services if required by
their insurance plan.
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