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Rights and Responsibilities

Member Rights

As a WellCare Advocate Managed Long Term Care Plan member, you have the right to:

  • Receive medically necessary care
  • Timely access to care and services
  • Privacy about your medical record and when you get treatment
  • Get information on available treatment options and alternatives, presented in a manner and language you understand
  • Get information in a language you understand; you can get oral translation services free of charge.
  • Get information necessary to give informed consent before the start of treatment
  • Be treated with respect and dignity
  • Get a copy of your medical records and ask that the records be amended or corrected. 
  • Take part in decisions about your health care, including the right to refuse treatment
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation
  • Get care without regard to sex, race, health status, color, age, national origin, sexual orientation, marital status, or religion
  • Be told where, when, and how to get the services you need from your managed long term care plan, including how you can get covered benefits from out-of-network providers if they are not available in the plan network
  • Complain to the New York state Department of Health or your local Department of Social Services and the right to use the New York state fair hearing system and/or a New York state external appeal, where appropriate.
  • Appoint someone to speak for you about your care and treatment

Member Responsibilities

As a WellCare Advocate Managed Long Term Care Plan member, you have the responsibility to:

  • Be an active participant in your care and make every effort to do as much as possible to help yourself be as independent as possible and as healthy as you can be 
  • Request and use the managed long term care services that are most appropriate to your needs and that help you to be as independent as possible. 
  • Get the most out of being a member of a managed long term care health plan by using services that are not regularly available to you through Medicaid and still get the care that you need
  • Go to a social day care program instead of getting personal care at home so that you can be with other people and keep physically fit and active
  • Get housekeeping services and home-delivered meals instead of having a home health aide so that you get only help that you need
  • Know about your chronic health care needs and learn as much as you can so that you know what’s important, how to monitor your own care and what to do when things change
  • Get prior authorization for services and treatments, as explained in your member handbook, except when you have an emergency
  • Let your Care Manager know as soon as you can if you have had an emergency
  • Use network providers that are part of the WellCare network
  • Keep appointments or notify your provider and your Care Manager, if appropriate, if you are not able to keep an appointment
  • Let your Care Manager know before time if you are planning on leaving the area
  • Make Medicaid surplus or “spend down” payments that HRA has set for you to WellCare Health Plans
  • Ask for help and information from your Care Manager or Member Services if you do not understand something or if you have concerns or problems
  • Let WellCare know if you have ideas about how we can make our plan better

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Last Updated On: 11/25/2015