Your Rights and Responsibilites as a Member

Your Member Rights

As a recipient of Medicaid and a member in a Plan, you also have certain rights. You have the right to:•    Be treated with courtesy and respect 
•    Have your dignity and privacy respected at all times 
•    Receive a quick and useful response to your questions and requests
•    Know who is providing medical services and who is responsible for your care and participate
in making decisions about your health care
•    Know what member services are available, including whether an interpreter is available
if you do not speak English
•    Know what rules and laws apply to your conduct
•    Be given information about your diagnosis, the treatment you need, choices of treatments, risks, and how these treatments will help you, regardless of cost or benefit coverage
•    Say no any treatment, except as otherwise provided by law
•    Be given full information about other ways to help pay for your health care
•    Know if the provider or facility accepts the Medicare assignment rate
•    To be told prior to getting a service how much it may cost you 
•    Get a copy of a bill and have the charges explained to you
•    Get medical treatment or special help for people with disabilities, regardless of race, national origin, religion, handicap, or source of payment
•    Receive treatment for any health emergency that will get worse if you do not get treatment
•    Know if medical treatment is for experimental research and to say yes or no to participating
in such research
•    Make a complaint when your rights are not respected
•    Ask for another doctor when you do not agree with your doctor (second medical opinion)
•    Get a copy of your medical record and ask to have information added or corrected in your record, if needed
•    Have your medical records kept private and shared only when required by law or with your approval
•    Decide how you want medical decisions made if you can’t make them yourself (advanced directive)
•    To file a grievance about any matter other than a Plan’s decision about your services
•    To appeal a Plan’s decision about your services
•    Receive services from a provider that is not part of our Plan (out-of-network) if we cannot
find a provider for you that is part of our Plan
•    Receive information about the Lighthouse Health Plan, its services, its practitioners
and providers and member rights and responsibilities
•    Make recommendations about Lighthouse Health Plan’s member rights and
responsibilities policy
•    Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation

Your Member Responsibilities

As a recipient of Medicaid and a member in a Plan, you also have certain responsibilities. You have the responsibility to:
•    Give accurate information about your health to your Plan and providers
•    Tell your provider about unexpected changes in your health condition
•    Talk to your provider to make sure you understand a course of action and what is expected of you
•    Listen to your provider, follow instructions and ask questions
•    Keep your appointments or notify your provider if you will not be able to keep an appointment
•    Be responsible for your actions if treatment is refused or if you do not follow the health care provider's instructions
•    Make sure payment is made for non-covered services you receive
•    Follow health care facility conduct rules and regulations
•    Treat health care staff with respect
•    Tell us if you have problems with any health care staff
•    Use the emergency room only for real emergencies
•    Notify your case manager if you have a change in information (address, phone number, etc.)
•    Have a plan for emergencies and access this plan if necessary for your safety
•    Report fraud, abuse and overpayment