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Member Rights and Responsibilities

Member Rights

As an 'Ohana CCS member, you have the right:

  • To get information about the plan, its services, its practitioners and its providers.
  • To get information about your rights and responsibilities.
  • To have the protections listed in the Patients' Bill of Rights and Responsibilities Act (HRS Chapter 432E).
  • To know the names and titles of the providers who take care of you.
  • To be treated with respect.
  • To be treated with dignity.
  • To privacy.
  • To decide with your provider on the care you get.
  • To talk about the care you need as it is related to your health conditions. This includes the choices and risks involved, regardless of the cost or benefit coverage. You must get this information in a way you understand.
  • To know about your health care needs after you get out of the hospital or leave a provider's office.
  • To refuse care, as long as you agree to be responsible for your decision.
  • To not take part in any medical research.
  • To file a grievance and/or an appeal about the plan or the care it provides. And to know that if you do, it will not affect how you are treated.
  • To be free from any form of restraint or seclusion as a means of force, discipline, convenience or retaliation.
  • To request and get a copy of your behavioral health records.
  • To request to amend or correct your behavioral health records.
  • To have your records kept private.
  • To make your health care wishes known by using advance directives.
  • To have input in the plan's member rights and responsibilities.
  • To use these rights no matter your sex, age, race, ethnicity, income, education or religion.
  • To have all plan employees honor your rights.
  • To get health care services that are accessible, comparable in amount, duration and scope to those provided under Medicaid Fee-for-Service and are sufficient in amount, duration and scope to reasonably be expected to achieve the purpose for which the services are furnished.
  • To get appropriate services that are not denied or cut back just because of diagnosis, type of illness or mental health condition.
  • To get all information in a way that you can easily understand, in alternative formats and in a manner that takes into consideration your special needs.
  • To get help in understanding the rules and benefits of the plan.
  • To get verbal interpretation services at no cost. This is for all non-English languages, not just those that are most common.
  • To be told that verbal interpretation is available to you, and how to get this service.
  • To get information about:
    • The basic features of managed care.
    • Who may or may not join the program.
    • The plan's responsibilities for coordination of care in a timely manner in order to make an informed choice (potential members).
  • To get a complete description of your right to leave the plan.
  • To get a notice of any major change in benefits. You must get this at least 30 days before the change is to go into effect.
  • To get full information about emergency and after-hours services.
  • To get the plan's policy on referrals for specialty care and other benefits that are not provided by the member's Case Manager/Agency or health care provider.
  • To have all these rights apply to the person you legally appoint to make decisions about your health care.
  • To freely exercise your rights, including those related to filing a grievance or appeal, and that the exercise of these rights will not adversely affect the way you are treated.
  • To receive a second opinion at no cost to the member.
  • To receive services out of network if the health plan is unable to provide them in network for as long as the health plan is unable to provide them in network and not pay more than he or she would have if services were provided in network.
  • To receive services according to the appointment waiting time standards.
  • To receive services in a culturally competent manner.
  • To receive services in a coordinated manner.
  • To have your privacy protected.
  • To be included in care plan development.
  • To have access to providers contracted with the health plan.
  • To have direct access to specialists (if you have a special health care need).
  • To be informed regarding the restrictions on freedom of choice among network providers.
  • To not have services arbitrarily denied or reduced in amount, duration or scope solely because of diagnosis, type of illness or condition.
  • To receive a description of cost-sharing responsibilities, if any.
  • To not be held liable for:
    • The health plan's debts in the event of insolvency.
    • The covered services provided to the member by the health plan for which Med-QUEST Division does not pay the health plan.
    • Covered services provided to the member for which Med-QUEST Division or the health plan does not pay the health care provider that furnishes the services; and payments of covered services furnished under a contract, referral or other arrangement to the extent that those payments are in excess of the amount the member would owe if the health plan provided the services directly.
  • To only be responsible for cost-sharing as described by your plan.
  • To be provided with written notice of any significant change related to member rights, responsibilities and procedures at least 30 days before the intended effective date of the change.

Member Responsibilities

You also have responsibilities as a member:

  • To give information that the plan and its providers need to give care.
  • To follow plans and instructions for care that you have agreed on with your Case Manager/Agency or health care provider.
  • To understand your health problems.
  • To help set treatment goals that you and your Case Manager/Agency or health care provider agree to.
  • To read the Member Handbook to understand how the plan works.
  • To always carry your 'Ohana CCS member ID card.
  • To always carry your Medicaid card.
  • To show your ID cards to each provider.
  • To notify 'Ohana CCS if you lose your member ID card.
  • To schedule appointments for all non-emergency behavioral health care through your Case Manager/Agency or health care provider.
  • To get a referral from your Case Manager/Agency or health care provider for specialty care.
  • To cooperate with the people providing your health care.
  • To be on time for appointments.
  • To notify the provider's office if you need to cancel or change an appointment.
  • To respect the rights of all providers.
  • To respect the property of all providers.
  • To respect the rights of other patients.
  • To not be disruptive in any provider's office.
  • To know the medicines you take, what they are for, and how to take them the right way.
  • To help your Case Manager/Agency or health care provider obtain copies of all of your previous health records.
  • To let the plan know within 48 hours, or as soon as possible, if you are admitted to the hospital or get emergency room care.
  • To call 'Ohana CCS to get information or get your questions answered. Call Customer Service toll-free at 1-866-401-7540 (TTY 711).