Medicaid : Rights And Responsibilities

YOUR MEMBER RIGHTS

As a member of WellCare you have the following rights:

• To receive all services that WellCare must provide.
• To be treated with respect and with regard for your dignity and privacy.
• To be sure that your medical record information will be kept private.
• To be given information about your health. This information may also be available to someone who you have legally “okayed” to have the information or who you have said should be reached in an emergency when it is not in the best interest of your health to give it to you.
• To be able to take part in decisions about your health care unless it is not in your best interest.
• To get information on any medical care treatment, given in a way that you can follow.
• To be sure that others cannot hear or see you when you are getting medical care.
• To be free from any form of restraint or seclusion used as a means of force, discipline, ease or revenge as specified in federal regulations.
• To ask and get a copy of your medical records and to be able to ask that the record be changed/corrected if needed.
• To be able to say “yes” or “no” to having any information about you given out unless WellCare has to by law.  To be able to say “no” to treatment or therapy. If you say “no,” the doctor or MCP must talk to you about what could happen and they must put a note in your medical record about it.
• To be able to file an appeal, a grievance (complaint) or state hearing.
• To be able to get all MCP written member information from the MCP:

– At no cost to you
– In the prevalent non-English languages of members in the MCP’s service area
– In other ways, to help with the special needs of members who may have trouble reading the information for any reason

• To be able to get help free of charge from WellCare and its providers if you do not speak English or need help in understanding information.
• To be able to get help with sign language if you are hearing-impaired.
• To be told if the health care provider is a student and to be able to refuse his/her care.
• To be told of any experimental care and to be able to refuse to be part of the care.
• To make advance directives (a Living Will).
• To file any complaint about not following your advance directive with the Ohio Department of Health.
• To change your primary care provider (PCP) to another PCP on WellCare’s panel at least monthly.
• WellCare must send you something in writing that says who the new PCP is and the date the change began.
• To be free to carry out your rights and know that the MCP, the MCP’s providers or ODJFS will not hold this against you.
• To know that the MCP must follow all federal and state laws and other laws about privacy that apply.
• To choose the provider that gives you care whenever possible and appropriate.
• If you are a female, to be able to go to a woman’s health provider on WellCare’s panel for covered woman’s health services.
• To be able to get a second opinion from a qualified provider on WellCare’s panel. If a qualified provider is not able to see you, WellCare must set up a visit with a provider not on our panel.
• To get information about WellCare from us.
• To contact the United States Department of Health and Human Services Office of Civil Rights and/or the Ohio Department of Job and Family Services Bureau of Civil Rights at the addresses below with any complaint of discrimination based on race, color, religion, sex, sexual orientation, age, disability, national origin, veteran’s status, ancestry, health status or need for health services.

Office of Civil Rights
United States Department of Health and Human Services
233 N. Michigan Ave.–Suite 240
Chicago, IL 60601
1-312-886-2359 (TTY 1-312-353-5693)
Bureau of Civil Rights
Ohio Department of Job and Family Services
30 E. Broad St., 30th Floor
Columbus, OH 43215
1-614-644-2703 or 1-866-227-6353
(TTY 1-866-221-6700)
Fax: 1-614-752-6381

• To ask for and get a copy of your medical records from your doctor. Also, to ask that the records be changed/corrected if needed. (Requests must be received in writing from you or the person you choose to represent you. The records will be provided at no cost. They will be sent within 14 days of receipt of the request.)

YOUR MEMBER RESPONSIBILITIES

You have responsibilities as a member:

• To give information that the plan and its doctors and providers need to provide care.
• To follow plans and instructions for care that you have agreed on with your doctor.
• To understand your health problems.
• To help set treatment goals that you and your doctor agree to.
• To read the member handbook to understand how WellCare works.
• To always carry your member card.
• To show your ID cards to each provider.
• To get a referral from your doctor when needed.
• To cooperate with the people providing your health care.
• To be on time for appointments.
• To notify the doctor’s office if you need to cancel or change an appointment.
• To respect the rights of all providers.
• To respect the property of all providers.
• To respect the rights of other patients.
• To not be disruptive in your doctor’s office.
• To know the medicines you take, what they are for and how to take them the right way.
• To assist your doctor in getting previous medical records.
• To let your plan know within 48 hours, or as soon as possible, if you are admitted to the hospital or receive emergency room care.