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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 hte 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.