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
