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Rights and Responsibilities

Your Member Rights

As a member of our health plan, you have the right to:
  • Get information about our plan, services, doctors, and providers
  • Get information about your rights and responsibilities
  • Know the names and titles of doctors and other health providers caring for you
  • Be treated with respect and dignity
  • Confidentiality and nondiscrimination
  • Have your privacy protected
  • Have a reasonable opportunity to choose your PCP and to change to another provider in a reasonable manner
  • Agree to or refuse treatment and actively participate in making decisions
  • Decide with your doctor on the care you get
  • Talk openly about care you need for your health, no matter the cost or benefit coverage, and the choices and risks involved (this information must be given in a way you understand)
  • Timely access to care that does not have any communication or physical access barriers
  • 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 the doctor’s office
  • Refuse care, as long as you agree to be responsible for your decision
  • Refuse to take part in any medical research
  • Complain about our plan or the care we provide; also, to know that if you do, it will not change how you’re treated
  • Not be responsible for our debts in the event of bankruptcy and not be held liable for:
    • Payments of covered services provided under a contract, referral or other arrangement to the extent that 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 used as a means of coercion, discipline, convenience or retaliation
  • Ask for and get a copy of your medical records from your doctor in accordance with applicable federal and state law; 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
  • Timely referral and access to medically needed specialty care
  • Have your records kept private
  • Make your health care wishes known through advance directives
  • Prepare advance medical directives
  • Have a say in our member rights and responsibilities policy
  • Use our grievance process to file a grievance, get help with filing an appeal, and get a hearing from us and/or the State
  • Appeal medical or administrative decisions by our or the State’s appeal process
  • Exercise these rights no matter your sex, age, race, ethnicity, income, education or religion
  • Have our staff observe your rights
  • Have all of the above rights apply to the person legally able to make decisions about your health care
  • Be furnished quality services, which include:
    • Accessibility
    • Authorization standards
    • Availability
    • Coverage
    • Coverage outside of network
    • The right to a second opinion
  • You also have the right to ask for more information about:
    • Our structure and operation
    • Our physician incentive plan
    • Our service utilization policies
    • How to report alleged marketing violations to Medicaid and Long-Term Care (MLTC)
    • Reports to the State about transactions between WellCare of Nebraska and other parties


Your Member Responsibilities

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

  • Know your member rights
  • Offer information that we and your providers need to give care
  • Follow WellCare of Nebraska’s and MLTC’s policies and procedures
  • Learn about your care and treatment options
  • Actively participate in personal health and care decisions, and practice healthy lifestyles
  • Report suspected fraud, waste and abuse
  • Follow plans and instructions for care that you have agreed on with your doctor
  • Understand your health problems
  • Help set treatment goals that you and your doctor agree to
  • Read your member handbook to understand how our health plan works
  • Carry your WellCare of Nebraska member ID card at all times
  • Carry your Medicaid ID card at all times
  • Show your ID cards to each provider
  • Schedule appointments for all non-emergency care through your PCP
  • Get a referral from your PCP when appropriate
  • Cooperate with the people who provide your health care
  • Be on time for appointments
  • Tell the doctor’s office if you need to cancel or change an appointment
  • 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
  • Know the medicines you take, what they are for, and how to take them the right way
  • Make sure your PCP has copies of all previous medical records
  • Let us 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

Tell WellCare of Nebraska immediately if you have an accident at work, car accident or are involved in a personal injury or malpractice lawsuit, or accident of any kind.

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Last Updated On: 3/2/2018