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MEMBER RIGHTS AND RESPONSIBILITIES
MEMBER RIGHTS
Members have the right to:
- Make an appointment with their doctor within a reasonable
time and have their doctor listen and work with them to take
care
of their health care needs.
- You and you doctor have the right to freely communicate about your care and treatment options regardless of any benefit coverage limitations.
- Choose a Primary Care Provider of their choice within the
Care1st network and know restrictions for their selection,
if any.
- Get preventive health care services
- Get minor consent services
- Get family planning services, treatment for any sexually transmitted
disease, emergency care services, from Federally Qualified Health
Centers, and/or Indian Health Services. Members do not need to
get Care1st Health Plan’s approval first
- Be informed when their doctor is no longer contracted with
Care1st Health Plan.
- A confidential (private) relationship with their doctor. No
one will talk about their health care unless they okay it.
- Polite, kind and helpful care no matter what race, religion,
sex, age, gender, cultural, or ethnic background.
- Say no to medical treatment, when permitted by law.
- Formulate advance directives.
- Know and understand their medical problem and treatment plan.
- Get a copy of their medical records and have them kept private.
- Get information and to be spoken to in the language that
they understand and are comfortable with. This means that Members
can
get free 24-hour interpreter services.
- Not be required to bring family/friends to interpret.
- Receive informing materials in alternative formats and large
size print upon request.
- File a grievance with Care1st Health Plan if they do not
receive services in the language they request.
- Get information on how to file appeals and grievances with
Care1st Health Plan, or directly to the state.
- Ask for a State
Fair Hearing by calling 1 (800) 952-5253. Members also have the
right to get information on how to get
an expedited
State Fair hearing.
- Receive a copy of the drug formulary upon request.
- A second opinion.
- Disenroll upon request
- Get an answer to a request for referrals.
• Routine or Regular –3 business days
• Urgent- 24 to 48 hours
• Emergency – same day
MEMBER RESPONSIBILITIES
Members are Responsible for:
- Participating in their health care and the health care of
their family. This means taking care of problems before they
become serious.
Members should follow their doctor’s instructions, take
their medications, and participate in health programs that keep
them
well.
- Using the Emergency Room for emergencies only. The Members
doctor will provide most of the medical care that Members
need.
- Being polite and helpful to people who give health care
services to the Member and their family.
- Making and keeping appointments for check-ups.
- Participating in Member Satisfaction Surveys.
- Reporting Health Care Fraud.
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