Member Rights and Responsibilities

As a member of WellCare of North Carolina, you have certain rights and responsibilities. WellCare of North Carolina will respect your rights. We make sure that no one working for our plan, or any of our providers, will prevent you from using your rights. Also, we will make sure that you are aware of your responsibilities as a member of our plan.

Your Rights

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

Receive information about WellCare of North Carolina, its services, its practitioners and providers, and member rights and responsibilities
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 PCP what health issues you may have, what can be done for you and what will likely be the result, in language you understand
An open discussion of treatment options for your conditions, regardless of cost or benefit coverage
Get a second opinion about your care
Give your approval of any treatment
Give your approval of any 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
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 WellCare of North Carolina complaint process to settle complaints. You can also contact the Medicaid Managed Care Ombudsman Program any time you feel you were not fairly treated (see page 66 for more information about the Ombudsman Program).
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
Make recommendations about WellCare of North Carolina’s member rights and responsibilities policy
Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints
File a complaint with the Department if they are not satisfied with their grievance resolution
Be informed of the availability of Medicaid transportation services at no cost
Have the transportation policy explained, including how to request or cancel a trip,
limitations on transportation, personal conduct, and no-shows
Be transported to medical appointments if unable to arrange or pay for transportation
- By means appropriate to circumstances
- To arrive at the medical provider in time for their scheduled appointment
- Be informed that a Member under the age of eighteen (18) does not have to ride alone and that member and/or attendants can ride at no additional cost
- Request a hearing if the request for transportation assistance is denied
- If you are a NC Health Choice Member, WellCare of North Carolina will also make sure that costs for covered benefits and services are not avoided by us by referring you to publicly supported health care resources

Your Responsibilities

As a member of WellCare of North Carolina, you agree to:

Work with your PCP to protect and improve your health
Supply information (to the extent possible) that WellCare of North Carolina and its practitioners and providers need in order to provide care
Find out how your health plan coverage works
Listen to your PCP’s advice and ask questions
Follow plans and instructions for care that you have agreed to with your practitioners
Call or go back to your PCP if you do not get better or ask for a second opinion
Treat health care staff with respect
Understand your health problems and work to create a care plan in which both you and your doctor agree
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 emergencies
Call your PCP when you need medical care, even if it is after hours
Use transportation resources which are available and appropriate to their needs in the most efficient and effective manner
Use transportation services, such as gas vouchers, appropriately
Travel to the requested location and receive a Medicaid covered service
Make timely requests for transportation assistance
Be ready and at the designated place and time for transportation pick
Cancel transportation services that are no longer needed
Follow the instructions of the driver
Respect and do not violate the rights of other passengers or the driver by not creating a disturbance or engaging in threatening language or behavior