You and Kaiser Permanente

• Receive information about Kaiser Permanente, our services, our health care practitioners and providers, and his/her rights and responsibilities.
• Get information about the people who provide health care including their names, professional status, and board certification.
• Be treated with consideration, compassion, and respect taking into account his/her dignity and individuality, including privacy in treatment and care.
• Be free from neglect, exploitation, and verbal, mental, physical and sexual abuse.
• Make decisions about your medical care. This includes advance directives to have life-prolonging medical or surgical treatment given, ended, or stopped, withholding resuscitative services, and care at the end of life. You have the right to assign another person to make health care decisions for you, to the extent allowed by law.
• Discuss all medically necessary treatment options, regardless of cost or benefit coverage.
• Voice your complaints or appeals about Kaiser Permanente or the care we provide freely without fear of discrimination or retaliation. If you are not satisfied with how your complaint was handled, you may have us reconsider his/her complaint.
• Make recommendations regarding Kaiser Permanente’s Member Rights and Responsibilities statement.
• Be involved and include your family in the planning of your medical care. You have the right to be informed of the risks, benefits, and consequences of his/her actions. You may refuse to participate in research, investigation and clinical trials.
• Refuse care, treatment and services.
• Choose your primary care physician, change your primary care physician, or obtain a second opinion within Kaiser Permanente. You also have the right to consult with a non-Plan doctor at your own expense.
• Have direct access to a specialist or qualified practitioner of women’s health services to assure your continuing care..
• Receive information and discuss with your doctor your medical condition, available treatment options, alternatives and diagnosis in a manner appropriate to your condition and your ability to understand.
• Obtain language interpretation services when required to understand your care and services.
• Be involved in the consideration of bioethical issues. You have the right to contact our Bioethics Committee for help in resolving ethical, legal, and moral matters relating to your care.
• Be informed of the relationship between Kaiser Permanente and other health care programs, providers, and schools.
• Be informed about how new technologies are evaluated in relation to benefit coverage.
• Receive the medical information and education you need to participate in your health care.
• Give informed consent before the start of any procedure or treatment.
• Give or withhold informed consent to produce or use recordings, films, or other images of the patient for purposes other than your own care.
• Have access to medically necessary services and treatment, including emergency treatment, and covered benefits, in a timely and fair way. Services should not be arbitrarily denied or reduced in amount, duration or scope because of diagnosis, type of illness, or condition.
• Receive services in a coordinated manner. Your PCP is in charge of your medical care. He or she treats you, refers you to specialists when needed, and connects you to all of our services. Your doctor will work with you to help you meet your health goals so that you can live well.
• Have your cultural, psychological, social, and spiritual needs considered and respected.
• Be assured of privacy and confidentiality of all communications and records related to your care and have your confidentiality protected. You or a person of your choosing can request and receive a copy of or access your medical records and request to amend or correct the record, within the limits of the law. In addition, you have the right to limit, restrict or prevent disclosure of PHI.
• Be treated in a safe, secure, and clean environment free from physical and drug restraints except when ordered by a doctor, or in the case of an emergency, when it is necessary to protect you or others from injury.
• Receive appropriate and effective pain management as an important part of your care plan.
• Get an explanation of his/her bill and benefits regardless of how he/she pays. You have the right to know about our available services, referral procedures, and costs.
• Receive other information and services required by various state or federal programs.
• When appropriate, be informed about the outcomes of care, including unanticipated outcomes. Be informed of the ability to change providers if other qualified providers are available.
• Discuss "do not resuscitate" wishes or advance directive instructions for healthcare with your surgeon and anesthesiologist prior to an operative procedure when you wish to have the “do not resuscitate” honored in the event of a life-threatening emergency during an operative procedure.
• File a complaint or voice a concern. You can provide comments or concerns to their personal physician or the departmental supervisor. You can also call or write to Member Services. We’ll respond within 30 days of receiving your comments and concerns.
  • Medicaid patients receiving services, including in the Ambulatory Surgery Center, who wish to file a complaint or voice a concern may contact the Medicaid Ombudsman, Hilopaa, at www.hilopaa.org, or by calling 1-808-791-3467 (Oahu), 1-808-270-1536 (Maui). Medicare patients may contact the Office of the Medicare Beneficiary Ombudsman @ www.medicare.gov.
  • Patients receiving services in the Ambulatory Surgery Center may also contact Accreditation Association for Ambulatory Health Care; 5250 Old Orchard Road, Suite 200, Skokie, IL 60077. Tel: 847-853-6060, Fax: 847-853-9028, or by email: info@aaahc.org.
  • Patients have the right to report complaints through the State of Hawaii Department of Health; 601 Kamokila Boulevard, Kakuhihewa Building, Room 395, Kapolei, HI 96707. Tel: 808-692-7420 or Fax: 808-692-7447.
• Receive services out-of-network if the health plan is unable to provide them in-network and not pay more than they would have if services were provided in-network.

• Provide accurate and complete information about your present and past medical condition.
• Follow the treatment plan agreed on by you and your health care practitioner. You have a responsibility to inform your health care practitioner if you do not understand or cannot follow through with your treatment.
• Understand your health problems and participate in developing mutually agreed upon treatment goals, to the extent possible.
• Identify yourself appropriately and use your Kaiser Permanente identification card in accordance with Kaiser Permanente policies and procedures.
• Cooperate with our staff to help ensure proper diagnosis and treatment of your illness or condition.
• Keep your appointments or if you cannot keep them, cancel appointments in a timely manner.
• Know your benefit coverage and its limitations.
• Cooperate in signing a release form when you choose to refuse recommended treatment or procedures.
• Realize the effects your lifestyle has on your health and understand that decisions you make in your daily life, such as smoking, can affect your health.
• Be considerate of others by respecting the rights and feelings of the staff and respect the privacy of other patients.
• Refrain from disturbing or disrupting medical care, facility operations or administration and cooperate with staff to allow services to other patients to be performed without interruption. Conduct that is disrespectful of others, abusive (verbally or physically), or threatening will not be tolerated.
• Follow all hospital, clinic, and health plan rules and regulations, including respecting hospital visiting hours.
• Cooperate in the proper processing of third party payments.
• Inform us when you or your covered dependents change addresses or other contact information.
• Be responsible for your actions. If you refuse treatment, or do not follow instructions it may be necessary stop attempted care temporarily, or take other appropriate action. Conduct that is disrespectful of others, abusive (verbally or physically), or threatening will not be tolerated and will result in appropriate actions and consequences.
• For Ambulatory Surgery Center (ASC) patients, provide a responsible adult to transport you home from the ASC and remain with you for 24-hours, if required by his/her provider.

As a person receiving our services, the patient has specific rights regardless of his/her age, cultural background, gender, gender identity, sexual orientation, financial status, national origin, race, religion, or disability. As a patient in the Moanalua Medical Center, you have the right to:

• Receive information about your rights and responsibilities when you are admitted.
• Receive orderly transfer and discharge for your welfare, for other patients’ welfare, or other causes as determined by his/her physician. Also, you have the right to receive reasonable advance notice and discharge planning by qualified hospital staff to help ensure appropriate post-hospital placement and care.
• Request visits by clergy at any time and participate in social and religious activities, unless doing so infringes on the rights of other patients or would compromise your medical care.
• Receive and use your own clothing and possessions as space permits, unless doing so infringes on the rights of other patients, is in violation of hospital safety practices, or would compromise your medical care.
• Give informed consent before the start of any recording, films, or other images for purposes of non-patient care.
• Access protective and advocacy services.
• Access appropriate educational services when a child or adolescent patient’s treatment necessitates a significant absence from school.
• Protection from requests to perform services for Kaiser Foundation Hospital that are not included for therapeutic purposes in your plan of care.
• Be free from any form of restraint or seclusion as a means of coercion, discipline, convenience or retaliation as specified in federal regulations on the use of restraints and seclusion.
• Receive visitors of your choice. All or certain visitors may be excluded at your request or discretion of staff, physicians, or administration to allow for your and other’s rights, safety or well-being.
• File a complaint in the hospital, either verbally or in writing, with the department manager or supervisor. If you are not satisfied with the response, the patient may contact Hospital Administration, which is located on the first floor of the hospital or reached through the operator at 808-432-0000.
• You may also contact The Joint Commission (an independent, not-for-profit organization that accredits and certifies health organizations and programs) by phone, mail, fax or email. Phone: Toll free U.S., Weekdays 8:30 a.m. – 5 p.m. Central time, 1-800-994-6610. Mail: Office of Quality Monitoring, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL. 60181. Fax: 630-792-5636. Email: complaint@jointcommission.org.

As a QUEST Integration member, you have a right to:

• Not be held responsible for Kaiser Permanente debts in the event of insolvency.
• Not be held responsible for services provided to you for which the Department of Human Services (DHS) does not pay Kaiser Permanente.
• Not be held responsible for covered services provided to you for which DHS or Kaiser Permanente does not pay the health care provider that performed the service.
• Not be held responsible for payments for covered services furnished under a contract, referral, or other arrangement to the extent that those payments are in excess of the amount you would owe if Kaiser Permanente provided the services directly.
• Direct access to a specialist through a standing referral or an approved number of visits if you are an enrollee with special health care needs, as determined through an assessment by an appropriate health care professional.
• Be included in the development of a service/treatment plan.
  Receive information on available treatment options and alternatives in a way that you can easily understand and in a manner that takes into consideration your special needs.
• Freely exercise your rights, including those related to filing a grievance or appeal, as described in 432E, HRS Patients’ Bill of Rights and Responsibilities. Exercising those rights does not adversely affect the way Kaiser Permanente treats you.
• Receive information in accordance with federal and State-specified information requirements for language, format, translation, interpretation, etc. [42 CFR 438.100(a)(1 and 2)].
• Be furnished health care services in accordance with requirements for access, availability, and quality of services (42CFR438.206 through 42CFR438.210).
• Receive services according to the appointment waiting time standards.
• Receive services in a culturally competent manner.
• Receive services in a coordinated manner.
• Obtain a second opinion within Kaiser Permanente. If the second opinion cannot be obtained from a Kaiser Permanente provider, arrangements will be made for a second opinion from an out-of-network provider. The authorized second opinion by an in- or out-of-network provider will be at no cost to you.
• Only be responsible for cost sharing in accordance with 42 CFR 447.50.

As a QUEST Integration member, you must notify:

• DHS and Kaiser Permanente when there are any of the following changes in his/her family:
  • Death in the family (recipient, spouse, dependent)
  • Birth
  • Adoption
  • Marriage
  • Divorce
  • Change in health condition (such as pregnancy or permanent disability)
  • Change of address
    Institutionalization (such as nursing home, state mental hospital or prison)

• You must notify Kaiser Permanente at 808-432-5330 or toll-free at 1-800-651-2237 if:
  • Another person, organization or program is liable for the cost of care for his/her illness or injury (such as no-fault insurance for a car accident, or worker's compensation for an injury on the job)
  • You will need continuing medical care while visiting on another island
  • You are going to be away from home for more than 90 days