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Rights and Responsibilities

P4HB® Participant Rights

You have the right:

  • To get information about the plan, its services and its doctors and providers.
  • To get information about your rights and responsibilities.
  • To know the names and titles of doctors and other health providers caring for you.
  • To be treated with respect and dignity.
  • To have your privacy protected.
  • To decide with your provider on the care you get.
  • To talk openly about care you need for your health, no matter the cost or benefit coverage, and the choices and risks involved. The information must be given in a way you understand.
  • To have the risks, benefits and side effects of medications and other treatments explained to you.
  • To know about your health care needs after you get out of the hospital or leave the provider’s office.
  • To refuse care, as long as you agree to be responsible for your decision.
  • To refuse to take part in any medical research.
  • To complain about the plan or the care it provides. Also, to know that if you do, it will not change how you are treated.
  • To not be responsible for the plan’s debts in the event of insolvency and not be held liable for:
    • Covered services provided to the participant for which DCH does not pay the contractor.
    • Covered services provided to the participant for which DCH or the plan does not pay the provider that furnished the services.
    • Payments of covered services furnished under a contract, referral or other arrangement to the extent that those payments are in excess of the amount the participant would owe if the contractor provided the services directly.
    • To be free from any form of restraint or seclusion as a means of force, discipline, convenience or revenge.
  • To 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.)
  • To have your records kept private.
  • To make your health care wishes known through advance directives.
  • To have a say in the plan’s P4HB® Participant rights.
  • To appeal medical or administrative decisions by using the plan or the state’s grievance process.
  • To exercise these rights no matter your sex, age, race, ethnicity, income, education or religion.
  • To have all plan staff observe your rights.
  • To have all the above rights apply to the person legally able to make decisions about your health care.
  • To be furnished services in accordance with 42 CFR 438.206 through 438.210, which include:
    • Accessibility
    • Authorization standards
    • Availability
    • Coverage
    • Coverage outside of network
    • The right to a second opinion
  • To be responsible for cost sharing only as specified under covered services co-payments.
  • To be responsible for cost sharing only as specified in the contract.

P4HB® Participant Responsiblities

You have the responsibility:

  • To give information that the plan, its doctors and providers need to provide care.
  • To follow plans and instructions for care that you have agreed on with your provider.
  • To understand your health problems.
  • To help set treatment goals that you and your provider agree to.
  • To read the P4HB® Participant handbook to understand how the plan works.
  • To carry your P4HB® Participant card at all times.
  • To carry your Medicaid card at all times.
  • To show your ID cards to each provider.
  • To schedule appointments for all non-emergency care through your provider.
  • To cooperate with the people who provide your health care.
  • To be on time for appointments.
  • To tell the provider’s office if you need to cancel or change an appointment.
  • To pay co-payments to providers, as specified by the Georgia Families program.
  • 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 provider’s office.
  • To know the medicines you take, what they are for and how to take them the right way.
  • To make sure your provider has copies of all previous medical records.
  • To let your plan know within 48 hours, or as soon as possible, if you are admitted to the hospital or get emergency room care.
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Last Updated On: 4/20/2021