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Member rights and responsibilities
1. To respect, dignity, privacy, confidentiality and
nondiscrimination. That includes the right to:
a. be treated fairly and with respect;
and
b. know that your medical records and
discussions with your providers will be kept private and
confidential.
2. To a reasonable opportunity to
choose a health care plan and primary care provider (the doctor
or health care provider you will see most of the time and who
will coordinate your care) and to change to another plan or
provider in a reasonably easy manner. That includes the right
to:
a. be informed of how to choose and
change your health plan and your primary care provider;
b. choose any health plan you want
that is available in your area and choose your primary care
provider from that plan;
c. change your primary care provider;
d. change your health plan without
penalty; and
e. be educated about how to change
your health plan or your primary care provider.
3. To ask questions and get answers
about anything you don’t understand. That includes the right to:
a. have your provider explain your
health care needs to you and talk to you about the different
ways your health care problems can be treated; and
b. be told why care or services were
denied and not given.
4. To consent to or refuse treatment
and actively participate in treatment decisions. That includes
the right to:
a. work as part of a team with your
provider in deciding what health care is best for you; and
b. say yes or no to the care
recommended by your provider.
5. To utilize each available complaint
and appeal process through the managed care organization and
through Medicaid, and receive a timely response to complaints,
appeals and fair hearings. That includes the right to:
a. make a complaint to your health
plan or to the state Medicaid program about your health care,
your provider or your health plan;
b. get a timely answer to your
complaint;
c. access the plan’s appeal process
and the procedures for doing so; and
d. request a fair hearing from the
state Medicaid program and request information about the process
for doing so.
6. To timely access to care that does
not have any communication or physical access barriers. That
includes the right to:
a. have telephone access to a medical
professional 24 hours a day, 7 days a week in order to obtain
any needed emergency or urgent care;
b. get medical care in a timely
manner;
c. be able to get in and out of a
health care provider’s office, including barrier free access for
persons with disabilities or other conditions limiting mobility,
in accordance with the Americans with Disabilities Act;
d. have interpreters, if needed,
during appointments with your providers and when talking to your
health plan. Interpreters include people who can speak in your
native language, assist with a disability, or help you
understand the information; and
e. be given an explanation you can
understand about your health plan rules, including the health
care services you can get and how to get them.
7. To not be restrained or secluded
when doing so is for someone else’s convenience, or is meant to
force you to do something you don’t want to do, or to punish
you.
1. To learn and understand each right
you have under the Medicaid program. That includes the
responsibility to:
a. learn and understand your rights
under the Medicaid program;
b. ask questions if you don’t
understand your rights; and
c. learn what choices of health plans
are available in your area.
2. To abide by the health plan and
Medicaid policies and procedures. That includes the
responsibility to:
a. learn and follow your health plan
rules and Medicaid rules;
b. choose your health plan and a
primary care provider quickly;
c. make any changes in your health
plan and primary care provider in the ways established by
Medicaid and by the health plan;
d. keep your scheduled appointments;
e. cancel appointments in advance when
you can’t keep them;
f. always contact your primary care
provider first for your non-emergency medical needs;
g. be sure you have approval from your
primary care provider before going to a specialist; and
h. understand when you should and
shouldn’t go to the emergency room.
3. To share information relating to
your health status with your primary care provider and become
fully informed about service and treatment options. That
includes the responsibility to:
a. tell your primary care provider
about your health;
b. talk to your providers about your
health care needs and ask questions about the different ways
your health care problems can be treated; and
c. help your providers get your
medical records
4. To actively participate in
decisions relating to service and treatment options, make
personal choices, and take action to maintain your health. That
includes the responsibility to:
a. work as a team with your provider
in deciding what health care is best for you;
b. understand how the things you do
can affect your health;
c. do the best you can to stay
healthy; and
d. treat providers and staff with
respect.
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