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Rights and Responsibilties

Your Rights

As a member of WellCare of North Carolina, you have a right to: 

  • Be cared for with respect without regard for health status, sex, race, color, religion, national origin, age, marital status, sexual orientation or gender identity
  • Be told where, when and how to get the services you need from WellCare of North Carolina
  • Be told by your Primary Care Provider (PCP) what is wrong, what can be done for you and what will likely be the result, in language you understand
  • Get a second opinion about your care
  • Give your approval of any treatment or plan for your care after that plan has been fully explained to you
  • Refuse care and be told what you may risk if you do
  • Get a copy of your medical record and talk about it with your PCP, and to ask, if needed, that your medical record be amended or corrected
  • Be sure that your medical record is private and will not be shared with anyone except as required by law, contract or with your approval
  • Use the State Fair Hearing system
  • Appoint someone you trust (relative, friend or lawyer) to speak for you if you are unable to speak for yourself about your care and treatment
  • Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints
  • Receive information about WellCare of North Carolina, its services, its practitioners and providers and member rights and responsibilities
  • Be treated with respect and recognition of your dignity and your right to privacy
  • Participate in making decisions about your health care
  • A candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage
  • Voice complaints or appeals about WellCare of North Carolina or the care if provides
  • Make recommendations regarding WellCare of North Carolina member rights or responsibilities policy

Your Responsibilities 

  • As a member of WellCare of North Carolina, you agree to:
  • Work with your PCP to protect and improve your health
  • Find out how your health plan coverage works
  • Listen to your PCP’s advice and ask questions when you are in doubt
  • Call or go back to your PCP if you do not get better or ask for a second opinion
  • Treat health care staff with the respect you expect yourself
  • Tell us if you have problems with any health care staff by calling Member Services at 1-866-799-5318
  • Keep your appointments. If you must cancel, call as soon as you can.
  • Use the emergency department only for real emergencies
  • Call your PCP when you need medical care, even if it is after-hours
  • Supplying information that WellCare of North Carolina and its practitioners and providers need in order to provider care
  • Follow plans and instructions for care that you have agreed to with your practitioners
Understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible
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Last Updated On: 9/17/2019