Members

Health care made easy

When you have a health problem, you may have questions about what’s covered. You may need help finding a provider near you. That’s why our Member Services team is here to help you.

Member Services is here Monday through Friday from 8 a.m. to 7 p.m. Eastern. Call us with questions about your benefits.

There may be times when a contracted provider cannot give you the care you need. If this happens, you may need to get care from a provider that is not contracted with the health plan. We must approve this first.

We only cover needed care or supplies.  We decide medical need by looking at the normal standards of care. We choose if the care meets these standards.

Please read your member handbook. It gives more facts on your covered benefits.

Call Medicaid Member Services at 1-800-441-5501
Call Long Term Care Member Services at 1-844-645-7371
Call Florida Healthy Kids Member Services at 1-844-528-5815

Your Rights and Responsibilities

Members have certain rights and responsibilities:

  • You have the right to have your privacy protected
  • You have the right to receive a prompt and reasonable response to questions and requests
  • You have the right to know who is providing services to you
  • You have the right to know the services that are available, including an interpreter if you don’t speak English
  • You have the right to know the rules and regulations about your conduct
  • You have the right to be given information about your health
  • You have the right to get service from out-of-network providers for emergency services
  • You have the right to get family planning services from any in-network Medicaid provider without referral or prior authorization
  • You have the right to be given information and counseling on the financial resources for your care
  • You have the right to know if the provider or facility accepts the assignment rate
  • You have the right to receive an estimate of charges for your care
  • You have the right to receive a bill and to have the charges explained
  • You have the right to be treated regardless of race, national origin, religion, handicap, or source of payment
  • You have the right to be treated in an emergency
  • You have the right to know if medical treatment is for purposes of experimental research and to give your consent or refusal to participate in such research
  • You have the right to file a grievance if you think your rights have been violated
  • You have the right to information about our doctors
  • You have the right to be treated with respect and with due consideration for your dignity and privacy
  • You have the right to receive information on available treatment options and alternatives presented in a manner appropriate to your condition and ability to understand
  • You have the right to participate in decisions regarding your health care, including the right to refuse treatment
  • You have the right to be free from any form of restraint or seclusion used as a means of coercion discipline, convenience, or retaliation
  • You have the right to request and receive a copy of your medical records and request that they be amended or corrected
  • You have the right to be provided health care services in accordance with federal and state regulations
  • You are free to exercise your rights, and the exercise of those rights does not adversely affect the way the health plan and its providers or the State agency treat you
  • You have the right to make a complaint about the health plan or the care it provides
  • You have the right to file a grievance about any matter other than an adverse benefit determination
  • You have the right to appeal a decision the health plan makes
  • You have the right to make a recommendation regarding the health plan’s member rights and responsibilities.
  • You should provide accurate and complete information about your health
  • You should report unexpected changes in your condition
  • You should report that you understand your care and what is expected of you
  • You should follow the treatment plan recommended
  • You should keep appointments
  • You should follow your doctor’s instructions
  • You should make sure your health care bills are paid
  • You should follow health care facility rules and regulations
  • You should understand your health problems and participate in starting equally agreed-upon treatment goals