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 as required by law.
  • To receive information about Coordinated Care, its services, our practitioners and providers.
  • To receive a copy of Member rights and responsibilities and the right to make recommendations regarding these rights and responsibilities.
  • To join your providers in making decisions about your healthcare.
  • To refuse any medical service, diagnoses or treatment or to accept any health service provided by Coordinated Care if you or your parent/guardian objects based on religious grounds.
  • To discuss treatment options, regardless of cost or benefit coverage.
  • To seek second opinions.
  • To get information about available experimental treatments and clinical trials and how such research can be accessed.
  • To obtain assistance with care coordination from your Primary Care Physician’s (PCP) office.
  • To receive care without restraint.
  • To express a concern or appeal about Coordinated Care or the care it provides. To get a response in a reasonable period of time.
  • To look at and get a copy of your medical records as permitted by law (one copy free of charge) and request that they be amended or corrected.
  • To make advance directives. You can also contact Member Services for more information.
  • To file any complaint about not following your advance directive with the Department of Health and Human Services (HHS).
  • To choose the provider that gives you care whenever possible and appropriate.
  • To receive health care services that are accessible, are comparable in amount, duration and scope to those provided under Medicaid Fee for Service (FFS) and are sufficient in amount, duration and scope to reasonably be expected to achieve the purpose for which the services are furnished.
  • To receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness, or medical condition.
  • To exercise the rights described here without any adverse effect on your treatment by HHS, Coordinated Care, its providers or contractors.
  • To be able to get all written member information from Coordinated Care:
  • At no cost to you
  • In the prevalent non-English languages of members in the service area.
  • In other ways, to help with the special needs of members who may have trouble reading the information for any reason.
  • To receive assistance in understanding the requirements and benefits of Coordinated Care.
  • To receive oral interpretation services free of charge for all non-English languages, not just those identified as prevalent.
  • To be notified that oral interpretation is available and how to access those services.

As a Member, we can expect of you:

  • To inform Coordinated Care of the loss or theft of an ID card.
  • To present the Coordinated Care ID card when using healthcare services.
  • To be familiar with Coordinated Care procedures to the best of the member’s abilities.
  • To call or contact Coordinated Care to obtain information and have questions clarified.
  • To provide Coordinated Care and participating network providers with accurate and complete medical information.
  • To follow the prescribed treatment of care recommended by the provider or letting the provider know the reasons the treatment cannot be followed, as soon as possible.
  • To make every effort to keep any agreed upon and/or follow-up appointments, and to access preventive care services.
  • To live healthy lifestyles and avoid behaviors known to be detrimental.
  • To provide accurate and complete information to Coordinated Care and all healthcare providers.
  • To become knowledgeable about Coordinated Care's coverage provisions, rules and restrictions.
  • To ask questions of providers to determine the potential risks, benefits, and costs of treatment alternatives, and then making care decisions after carefully weighing all pertinent factors.
  • To follow the grievance process established by Coordinated Care if there is a disagreement with a provider.

You may access a printed copy here:

Member Rights & Responsibilities - English | Spanish