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Rights and Responsibilities

Your Member Rights

As a member in our plan, you have the right to:

  • Get information about our health plan, services and providers.
  • Get information about your rights and responsibilities.
  • Know the names and titles of providers caring for you.
  • Be treated with respect and dignity.
  • Have your privacy protected.
  • Decide with your provider on the care you get.
  • Talk openly about care you need for your health, no matter the cost or benefit coverage, and the treatment choices and risks involved (the information must be given in a way you understand).
  • Have the risks, benefits and side effects of medications and other treatments explained to you.
  • Know about your health care needs after you get out of the hospital or leave a provider’s office.
  • Refuse care, as long as you agree to be responsible for your decision.
  • Refuse to take part in any medical research.
  • File a grievance or administrative review about our plan or the care we provide; also, to know that if you do, it will not change how you are treated.
  • Not be responsible for our debts in the event of bankruptcy and not be held liable for:
    • Covered services provided to you for which the government does not pay us.
    • Covered services provided to you for which the government or we do not pay the provider who furnished the services.
    • Payments of covered services under a contract, referral or other arrangement to the amount those payments are in excess of the amount you would owe if we provided the services directly.
  • Be free from any form of restraint or seclusion as a means of force, discipline, convenience or revenge.
  • Ask for and get a copy of your medical records from your provider; 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.
  • Have your records kept private.
  • Make your health care wishes known through advance directives.
  • Have a say in our member rights.
  • Appeal medical or administrative decisions by using our grievance and administrative review process.
  • Exercise these rights no matter your sex, age, race, ethnicity, income, education or religion.
  • Have our staff observe your rights.
  • Have all the above rights apply to the person legally able to make decisions about your health care.
  • Be provided quality services in accordance with 42 CFR 438.206 through 438.210, including:
    • Accessibility
    • Authorization standards
    • Availability
    • Coverage
    • Coverage outside of network
    • The right to a second opinion

Your Member Responsibilities

As a member in our plan, you have the responsibility to:

  • Read the member handbook to understand how our health plan works.
  • Carry your member ID card at all times.
  • Show your member ID card to each provider.
  • Carry your Medicaid card at all times.
  • Give information that we and your providers need to give care.
  • Follow health plans and instructions for care that you have agreed on with your provider.
  • Cooperate with the people who provide your health care
  • Understand your health problems
  • Know the medicines you take, what they are for and how to take them the right way.
  • Help set treatment goals that you and your provider agree to
  • Schedule appointments for all non-emergency care through your provider.
  • Be on time for appointments.
  • Tell the provider's office if you need to cancel or change an appointment.
  • Get a referral from your provider for specialty care.
  • Pay co-payments to providers, as specified by the Georgia Families® program.
  • Respect the rights of all providers.
  • Respect the property of all providers.
  • Respect the rights of other patients.
  • Not be disruptive in your doctor’s office.
  • Make sure your doctor has copies of all previous medical records.
  • Let your plan know within 48 hours, or as soon as possible, if you are admitted to the hospital or get emergency room care.
  • Be responsible for cost sharing only as specified under covered services co-payments

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Last Updated On: 3/16/2017