Current through September 17, 2024
The following rights and responsibilities apply to a member
participating in Heritage Health. The health plans haves the requirement to
inform the member, in writing and verbally, regarding their rights and
responsibilities. No person may be subjected to discrimination in any
Departmental program or activity based on their race, color, sex, age, national
origin, religious creed, political beliefs, or disability.
002.01
MEMBER
RIGHTS. The member has the right to:
(A) Be treated with respect, dignity, and
without discrimination or retaliation;
(B) Be given information about their illness,
or medical condition; understand the treatment options, risks and benefits; and
make an informed decision about whether they will receive treatment;
(C) Participate in decisions about their
healthcare including the right to refuse treatment;
(D) Talk with their doctor and health plan
and know their medical information will be kept confidential;
(E) Choose their health plan and primary care
physician provider;
(F) Have access
to their health plan and primary care provider;
(G) Receive medical care in a timely
manner;
(H) Request a copy of their
medical record and request changes to their medical record;
(I) Make a complaint about the provider or
health plan, and receive a timely response;
(J) Receive information on the medical
services provided by their health plan;
(K) Change their primary care provider at any
time;
(L) Change their health plan
within 90 days of initial enrollment or every 12 months without cause
thereafter;
(M) Have Heritage
Health and health plan materials explained or interpreted;
(N) Have interpreters at no cost, if
necessary, during medical appointments and in all discussions with their
primary care provider or health plan;
(O) Request an appeal if services are denied,
terminated, or reduced;
(P) Make
advance directives, if desired, and receive assistance if needed; and
(Q) Receive proper medical care twenty-four
(24) hours a day, seven (7) days a week.
002.02
MEMBER
RESPONSIBILITIES. The member has the responsibility to:
(A) Understand, to the best of his or her
ability, how Heritage Health is used to receive health care;
(B) Choose a primary care provider within the
health plan's network;
(C) Take
their Medicaid ID card and health plan ID card to all medical appointments and
to the pharmacy for prescriptions;
(D) Keep their scheduled
appointments;
(E) Call their
doctor's provider's office at least 24 hours in advance if their appointment
must be rescheduled;
(F) Tell their
doctor about any medical problems;
(G) Ask questions about things they do not
understand;
(H) Follow the
provider's orders and advice;
(I)
Assist with the transfer of their medical records;
(J) Receive services from their primary care
provider unless referred elsewhere by their primary care provider;
and
(K) Cooperate with all Heritage
Health inquiries and surveys.
002.03
PROVIDER RIGHTS AND
RESPONSIBILITIES. Providers participating in Heritage Health or
Dental Benefits Manager have the same rights and responsibilities as any
Medicaid enrolled provider pursuant to Title 471 NAC.
