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.
Join our Member Advisory Board and be a voice in your community
We value your ideas and suggestions to change and improve our service to you. Do you have an idea you’d like to share with us? If so, we invite you to call Member Services.
Your ideas could be helpful to all our members. We have a group made up of our members and their caregivers, who share the same goals as you. This group is our Member Advisory Board (MAB). They meet during the year to review member materials and member feedback, as well as look at changes and new programs. They let us know how we can improve our services.
We’re always looking for members to help us find better ways to do things. You’re welcome to join our Member Advisory Board.
If you are interested in the MAB or have questions in general, call Member Services at:
Medicaid - 1-800-441-5501
Comprehensive Long Term Care - 1-844-645-7371
Your Rights and Responsibilities
As a recipient of Medicaid and a member in a Plan, you also have certain rights. You have the right to:
- Be treated with courtesy and respect
- Have your dignity and privacy respected at all times
- Receive a quick and useful response to your questions and requests
- Know who is providing medical services and who is responsible for your care
- Know what member services are available, including whether an interpreter is available if you do not speak English
- Know what rules and laws apply to your conduct
- Be given information about your diagnosis, the treatment you need, choices of treatments, risks, and how these treatments will help you
- Say no any treatment, except as otherwise provided by law
- Be given full information about other ways to help pay for your health care
- Know if the provider or facility accepts the Medicare assignment rate
- To be told prior to getting a service how much it may cost you
- Get a copy of a bill and have the charges explained to you
- Get medical treatment or special help for people with disabilities, regardless of race, national origin, religion, handicap, or source of payment
- Receive treatment for any health emergency that will get worse if you do not get treatment
- Know if medical treatment is for experimental research and to say yes or no to participating in such research
- Make a complaint when your rights are not respected
- Ask for another doctor when you do not agree with your doctor (second medical opinion)
- Get a copy of your medical record and ask to have information added or corrected in your record, if needed
- Have your medical records kept private and shared only when required by law or with your approval
- Decide how you want medical decisions made if you can’t make them yourself (advanced directive)
- To file a grievance about any matter other than a Plan’s decision about your services.
- To appeal a Plan’s decision about your services
- Receive services from a provider that is not part of our Plan (out-of-network) if we cannot find a provider for you that is part of our Plan
Long Term Care (LTC) Members have the right to:
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation
- Receive services in a home-like environment regardless where you live
- Receive information about being involved in your community, setting personal goals and how you can participate in that process
- Be told where, when and how to get the services you need
- To be able to take part in decisions about your health care.
- To talk openly about the treatment options for your conditions, regardless of cost or benefit
- To choose the programs you participate in and the providers that give you care
As a recipient of Medicaid and a member in a Plan, you also have certain responsibilities. You have the responsibility to:
- Give accurate information about your health to your Plan and providers
- Tell your provider about unexpected changes in your health condition
- Talk to your provider to make sure you understand a course of action and what is expected of you
- Listen to your provider, follow instructions and ask questions
- Keep your appointments or notify your provider if you will not be able to keep an appointment
- Be responsible for your actions if treatment is refused or if you do not follow the health care provider's instructions
- Make sure payment is made for non-covered services you receive
- Follow health care facility conduct rules and regulations
- Treat health care staff with respect
- Tell us if you have problems with any health care staff
- Use the emergency room only for real emergencies
- Notify your case manager if you have a change in information (address, phone number, etc.)
- Have a plan for emergencies and access this plan if necessary for your safety
- Report fraud, abuse and overpayment
LTC Members have the responsibility to:
- Tell your case manager if you want to disenroll from the Long-term Care program
- Agree to and participate in the annual face-to-face assessment, quarterly face-to-face visits and monthly telephone contact with your case manager