Member Rights and Responsibilities
As a Member you have the right to:
- Be treated with respect and dignity, and the right to privacy and nondiscrimination.
- Receive information about Coordinated Care, our services, practitioners and providers.
- Receive a copy of the Member rights and responsibilities and to make recommendations about these rights and responsibilities.
- Make decisions with your provider about your healthcare.
- Refuse or accept any health service, diagnoses or treatment based on religious grounds.
- Be informed about all treatment options available, regardless of cost. This includes clinical trials and experimental treatments.
- Seek second opinions.
- Express a concern or appeal about Coordinated Care or the care it provides and get a response in a reasonable amount of time.
- Ask for and receive a copy of your medical records as permitted by law (one copy free of charge) and request corrections when needed.
- Make advance directives and file a complaint with the Department of Health and Human Services (DHHS) if your advance directive is not followed.
- Choose a network provider that gives you care whenever possible and appropriate, including behavioral health providers.
- Receive health care services that are accessible, sufficient and comparable in amount, duration and scope to those services covered by Apple Health using your ProviderOne services card (also called fee-for-service).
- Receive services without restraint that are appropriate and are not denied or reduced solely because of diagnosis, type of illness, or medical condition.
- Exercise the rights described here without any adverse effect on your treatment by DHHS, Coordinated Care, its providers or contractors.
- Receive all written member information from Coordinated Care:
- At no cost to you
- In your preferred language
- In other ways, to help members who may have trouble reading the information for any reason.
- Receive assistance understanding the requirements and benefits of Coordinated Care.
- Be notified that oral interpretation is available and how to access those services.
- Receive oral interpretation services free of charge for non-English languages.
As a Member, we can expect you to:
- Present your Coordinated Care ID card when using healthcare services.
- Be familiar with Coordinated Care procedures and benefits to the best of your abilities.
- Give Coordinated Care and providers accurate and complete medical and insurance information.
- Follow the treatment recommended by the provider or let the provider know why treatment cannot be followed, as soon as possible.
- Make every effort to keep appointments and access preventive care services.
- Follow Coordinated Care’s grievance process if there is a disagreement with a provider.