MEMBER RIGHTS & RESPONSIBILITIES

ADVANTAGE Care Select members have rights and responsibilities. These are listed below. It is important that you read and understand each one. If you have questions, please ask your Care Manager.

You, your family or your guardian(s) have the right to certain kinds of information. This includes:

• The names of your PMP and Care Manager.
• One copy of your medical records at no cost to you. You may not be able to get a copy of medical records that are psychotherapy notes put together for a civil, criminal or administrative action.
• A description of covered services.
• Any services that ADVANTAGE Care Select or our providers do not cover because of moral or religious reasons, and information about how to get these services.
• Information about ADVANTAGE Care Select, its services, providers and your rights and responsibilities as a member.
• How ADVANTAGE Care Select provides for after hours and emergency care.
• What treatment choices or other types of care are available to you and the benefits and/or drawbacks of each choice.
• How to get services, including prior authorization of services.
• Your wishes about medical decision (advance directives) and information on how to have medical decisions made for you if you are not able to make them for yourself.
• Changes to your services or what to do if your doctor leaves ADVANTAGE Care Select.

You also have the right to be treated with respect and dignity.

• You can get covered services without concern about health status or need for health care services, payer source, race, ethnicity, national origin (to include those with limited English proficiency), religion, gender, age, mental or physical disability, sexual orientation, genetic information, ability to pay or ability to speak English.
• You can get quality medical services that support your personal beliefs, medical condition and background in a language you understand.
• You can get interpretation services if you do not speak English or have a hearing or vision problem to help you get the medical services you need. You may ask for materials in an alternative format or have them read to you.
• You can say no to drugs or restraints, except for times when your doctor thinks it is needed to protect you or others from harm.
• You have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.

You have the right to be part of treatment decisions.

• You can choose a doctor from ADVANTAGE Care Select’s provider network to plan your health care.
• You can change your doctor if you want to.
• You can talk with your doctor to get complete and current information about your health care and condition so that you and/or your family understand and can be a part of making decisions about your health care.
• You can be informed about which procedures you will have and who will do them.
• You can decide who you want to be with you for treatments and exams.
• You can have a female in the room for breast and pelvic exams.
• You can say no to treatment or services and be told what may happen if you do not have the treatment. Your eligibility or medical care does not depend on your agreement to follow a treatment plan.

You also have the right to:

Emergency Care:

You can get emergency health care services without the approval of your doctor or ADVANTAGE Care Select when you have a medical emergency. You may go to any emergency room or other setting for emergency care.

Specialty Services:

• You may get behavioral health services without the approval of your doctor or ADVANTAGE Care Select.
• You can see a specialist with a referral from your doctor.
• You can refuse care from a doctor you were referred to and ask for a second opinion.

Confidentiality and Privacy:

You have a right to privacy and confidentiality of your health care information.

You have a right to talk to health care professionals privately.

If you are unhappy with a decision, you may report your concerns to the Health Plan.

• Tell us about any complaints or issues you have with your health care services.
• You may file an appeal and get a decision in a reasonable amount of time.
• You can give ADVANTAGE Care Select suggestions on changes to policies and services.

Your Responsibilities as an ADVANTAGE Care Select Member:

As a member, you, your family or your guardian(s) have these responsibilities:

Respect

• Respect the doctors, pharmacists, nurses, staff and people providing services to you.
• Protect your member ID card.
• Take care of equipment loaned to you, like wheelchairs and the things that belong to the place where you live.
• Be considerate of the rights of the staff and other people if you are sharing a living arrangement. Be respectful of their property.

Share Information

• Show your member ID card or identify yourself as an ADVANTAGE Care Select member to health care providers before you get services. If you have other insurance in addition to ADVANTAGE Care Select, show your doctor or pharmacist your other insurance ID card as well.
• If you do not understand your health condition or treatment plan, ask your doctor to explain.
• Tell your doctor and Care Manager about any other insurance you may have, and apply for other benefits you may be eligible for.
• Give your doctor and Care Manager all the facts about your health problems, past illnesses, hospital stays, all medications, shots and other health concerns. Let your doctor and/or your Care Manager know about any changes in your condition.
• Report changes like your address, phone number and/or assets, and other matters that could affect your eligibility to your Care Manager and/or to the eligibility interviewer at the office where you applied for ADVANTAGE Care Select.

Follow Instructions

• Know the name of your assigned doctor and your Care Manager.
• Follow the instructions that you, your Care Manager and your doctor have agreed on. Ask what can happen if you do not follow these instructions.

Appointments

• Schedule appointment during office hours when possible, instead of using urgent or emergency care.
• Keep appointments and come on time. Call your doctor’s office ahead of time when you cannot keep your appointment.
• If you need help with transportation, contact Member Services at: 1-800-784-3981.

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