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Rights and Responsibilities

As Our Member, You Have the Right to:

  • Get information about our plan, services, doctors and other health care providers
  • Get information about your rights and responsibilities
  • Know the names and titles of the doctors and other health providers caring for you
  • Be treated with respect and dignity
  • Have your privacy protected
  • Choose your PCP from our network of providers
  • Decide with your doctor on the care you get
  • Have services provided that promote a meaningful quality of life and autonomy, independent living in your home and other community settings as long as it’s medically and socially feasible, and preserves and supports your natural support systems
  • Talk openly about the care you need, no matter the cost or benefit coverage, your treatment options and the risks involved. (This information must be given in a way you understand.)
  • Have the benefits, risks and side effects of medications and other treatments explained to you
  • Know about your health care needs after you leave your doctor’s office or get out of the hospital
  • A second medical opinion
  • Refuse care, as long as you agree to be responsible for your decision
  • Refuse to take part in any medical research
  • Voice your complaint or grievance about your 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 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 WellCare provided the services directly
  • Be free from hazardous procedures or 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 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).
  • Have your records kept private
  • Make your health care wishes known through advance directives
  • Have a say in our member rights and responsibilities policies and recommend changes to other policies and services we cover
  • Appeal medical or administrative decisions by using our appeals and grievances process
  • Exercise these rights no matter your sex, age, race, ethnicity, income, education or religion
  • Have our staff observe your rights
  • Have all of these rights apply to the person legally able to make decisions about your health care
  • Be furnished quality services in accordance with 42 CFR 438.206 through 438.210, which include:
    • Accessibility
    • Authorization standards
    • Availability
    • Coverage
    • Coverage outside of the network

As Our Member, You Have the Responsibility to:

  • Read your member handbook to understand how our plan works
  • Carry your member ID card at all times
  • Give information that we and your doctors and providers need to provide care to you
  • 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
  • Carry your Medicaid card at all times
  • Show your member ID card to each provider when you get care
  • Schedule appointments for all non-emergency care through your doctor
  • Get a referral from your doctor for specialty care
  • Cooperate with the people who provide your health care
  • Be on time for appointments
  • Tell your doctor’s office if you need to cancel or change an appointment
  • Pay your co-pays to providers
  • Respect the rights and property of all providers
  • Respect the rights of other patients
  • Not be disruptive at your doctor’s office
  • Know the medicines you take, what they are for and how to take them the right way
  • Make sure your doctor has copies of all of your 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-pays
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Last Updated On: 4/20/2021