STAR | Rights and Responsibilities | Quality Improvement

STAR Member Rights and Responsibilities

Members Rights:

To Respect, dignity, privacy, confidentiality and nondiscrimination. That includes the right to:

Be treated fairly and with respect; and
Know that your medical records and discussions with your providers will be kept private and confidential.

To a reasonable opportunity to choose a health care plan and primary care provider (the doctor or health care provider you will see most of the time and who will coordinate your care) and to change to another plan or provider in a reasonably easy manner. That includes the right to:

Be informed of how to chose and change health plans and primary care provider;
Choose any health plan you want that is available in your area and choose a primary care provider from that plan;
Change your primary care provider;
Change your health plan without penalty; and
Be educated about how to change your health plan or your primary care provider.

To ask questions and get answers about anything you do not understand. That includes the right to:

Have your provider explain your health care needs to you and talk to you about the different ways your health care problems can be treated; and
Be told why care or services were denied and not given.

To consent to or refuse treatment and actively participate in treatment decisions. That includes the right to:

Work as part of a team with your provider in deciding what health care is best for you; and
Say yes or no to the care recommended by your provider.

To utilize each available complaint and appeal process through the managed care organization and through STAR, and receive a timely response to complaints, appeals and fair hearing. That includes the right to:

make a complaint to your health plan or to the state STAR program about your health care, your provider or your health plan;
get a timely answer to your complaint;
access the plan's appeal process and the procedures for doing so; and
request a fair hearing from the state STAR program and request information about the process for doing so.

To timely access to care that does not have any communication or physical access barriers. That includes the right to:

Have telephone access to a medical professional 24 hours a day, 7 days a week in order to obtain any needed emergency or urgent care;
Get medical care in a timely manner,
Be able to get in and out of a health care provider's office, including barrier free access for person with disabilities or other conditions limiting mobility, in accordance with the Americans with Disabilities Act;
Have interpreters, if needed, during appointments with your providers and when talking to your health plan. Interpreters include people who can speak in your native language, assist with a disability, or help you understand the information; and
be given an explanation you can understand about your health plan rules, including the health care services you can get and how to get them.

To not be restrained or secluded when doing so is for someone else's convenience, or is meant to force you to do something you don't want to do or to punish you.

You Have the Responsibility to:

To learn and understand each right you have under the STAR program. That includes the responsibility to:

Learn and understand your rights under the STAR program;
Ask questions if you don't understand your rights; and
Learn what choices of health plans are available in your area.

To abide by the health plan and STAR policies and procedures. That includes the responsibility to :

Learn and follow your health plan rules and STAR rules;
Choose your health plan and primary care provider quickly;
Make any changes in your health plan and primary care provider in ways established by STAR and by the health plan;
Keep your scheduled appointments;
Cancel appointments in advance when you can't keep them;
Always contact your primary care provider first for non-emergency medical needs;
Be sure you have approval from your primary care provider before going to a specialist; and
Understand when you should and should not go to the emergency room.

To share information relating to your health status with your primary care provider and become fully informed about service and treatment options. That includes the responsibility to:

Tell your primary care provider about your health;
Talk to your providers about your health care needs and ask questions about the different ways your health care problems can be treated; and
Help your providers get your medical records.

To actively participate in decisions relating to service and treatment options, make personal choices, and take action to maintain your health. That includes the responsibility to:

Work as a team with your provider in deciding what health care is best for you;
Understand how the things you do can affect your health;
Do the best you can to stay healthy; and
Treat providers and staff with respect

return to the top