User Manual

Appendix
155
Cus
tomer’s Bill of Rights and Responsibilities
You
have the right to:
1. Receive considerate and respectful service.
2. Receive service without regard to race, creed, national origin,
sex, age, disability, sexual orientation, illness, or religious affili-
ation.
3. Expect confidentiality of all information pertaining to you,
your medical care and service. Please review our HIPAA Pri-
vacy Notice later in this section.
4. Receive a timely response to your request for service.
5. Receive continued service.
6. Select the medical equipment supplier of your choice.
7. Make informed decisions regarding your care planning.
8. Understand what services will be provided to you.
9. Obtain an explanation of charges, including policy for pay-
ment.
10. Agree to or refuse any part of the plan of service or plan of
care.
11. Voice complaints without fear of termination of service or
other reprisals.
12. Have your communication needs met.
You have the responsibility to:
1. Ask questions about any part of the plan of service or plan of
care that you do not understand.
2. Use the equipment for the purpose for which it was pre-
scribed, following instructions provided for use, handling
care, safety and cleaning.
3. Supply Insulet Corporation with insurance information nec-
essary to obtain payment for services.
4. Be accountable for charges not covered by your insurance.
You are responsible for settlement in full of your account.
5. Notify us immediately of:
a. Equipment failure, damage or need of supplies.
b. Any change in your prescription or physician.
c. Any change or loss in insurance coverage.
d. Any change of address or telephone number, whether
permanent or temporary.