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Rights and Responsibilities

Staywell Member Rights

  • Enrollees have the right to be treated with respect and with due consideration for their dignity and privacy.
  • Enrollees have the right to receive information on available treatment options and alternatives, presented in a manner appropriate to the enrollee’s condition and ability to understand.
  • Enrollees have the right to participate in decisions regarding their health care, including the right to refuse treatment.
  • Enrollees have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • Enrollees have the right to request and receive a copy of their medical records, and request that they be amended or corrected. (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.)
  • Enrollees have the right to be furnished health care services in accordance with federal and state regulations.
  • The State must ensure that each enrollee is free to exercise his or her rights, and that the exercise of those rights does not adversely affect the way the health plan and its providers or the State agency treat the enrollee.

As a Staywell member, you also have the right:

  • To get details about what the plan covers and how to use its services and plan providers.
  • To have your privacy protected.
  • To know the names and titles of doctors and others who treat you.
  • To talk openly about care needed for your health, no matter the cost or benefit coverage. To freely talk about care options and risks involved. To have this information shared in a way you understand.
  • To know what to do for your health after you leave the hospital or office.
  • To refuse to take part in research.
  • To get a proper reply to your complaints.
  • To create an advance directive.
  • To suggest ways the plan can improve.
  • To appeal health care decisions using the proper steps.
  • To have a say in the plan’s member rights.
  • To have all these rights apply to the person who can legally make health care decisions for you.
  • To have all health plan staff members observe your rights.
  • To use these rights no matter what your sex, age, race, ethnic, economic, educational or religious background

Staywell Member Responsibilities

As a Staywell member, you have the responsibility:

  • To know how Staywell works by reading this handbook.
  • To carry your Staywell ID card and Medicaid Gold Card with you at all times. And to present them when you get health care services.
  • To get non-emergency care from a primary doctor, to get referrals for specialty care, and to work with those giving you care.
  • To be on time for appointments.
  • To cancel or set a new time for appointments ahead of time.
  • To report unexpected changes to your provider.
  • To respect doctors, staff and other patients.
  • To help set treatment goals that you and your doctor agree to.
  • To follow the treatment plan you and your provider agree on.
  • To understand medical advice. Ask questions if you do not.
  • To know about the medicine you take, what it is for, and how to take it.
  • To provide information needed to treat you.
  • To make sure your doctor has your previous medical records.
  • To tell Staywell within 48 hours, or as soon as you can, if you are in a hospital or go to an emergency room.
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Last Updated On: 5/5/2021
WellCare will be performing maintenance on Saturday, May 21 (from 6 PM EDT to 8 AM EDT the next day). You might not be able to access systems or fax during this time. We are sorry for any issues this may cause. Thank you for your patience. If you need assistance, contact us.