CHIP | Rights and Responsibilities | Quality Improvement

CHIP Member Rights and Responsibilities

Members Rights:

To help you make good choices about your child's health plan, doctors, hospitals and other providers.That includes the right to:

Have to get accurate, easy-to-understand information

Limited provider network " is a group of doctors and other providers who only refer patients to other doctors who are in the same group. Meaning, you cannot see all the doctors who are in your health plan. If a health plan uses "limited networks", members have the rights:

To check to see that your child's primary care provider and any specialist doctor you might like to see are part of the same "limited network."

To know how your doctors are paid.That includes the rights:

Some get a fixed payment no matter how often you visit.
Others get paid based on the services they give to your child.
To know about what those payments are and how they work.

To know about the healthplan and the services provided:That includes the rights :

To know how the health plan decides about whether a service is covered and/or medically necessary.
To know about the people in the health plan who decides those things.
Rights to know the names of the hospitals and other providers in your health plan and their addresses

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;

Child is confirmed to have special health care needs or a disability.It includes the rights:

To use a specialist as your child's primary care provider.

Children who are confirmed to have special health care needs or a disability have the right to special care.

If your child has special medical problems, and the doctor your child is seeing leaves your health plan,then the member have the rights:

To be able to continue seeing that doctor for three months and the health plan must continue paying for those services.
Your daughter has the right to see a participating obstetrician/gynecologist (OB/GYN) without a referral from her primary care provider and without first checking with your health plan.
Some plans may make you pick an OB/GYN before seeing that doctor without a referral.

If your child's life is in danger, or that your child would be seriously hurt without getting treated right away,it includes the rights:

To get the emergency services when you need them
Coverage of emergencies is available without first checking with your health plan.
You may have to pay a few dollars depending on your income. This is called a co-payment.
Have the right and responsibility to take part in all the choices about your child's health care.
You have the right to speak for your child in all treatment choices.
You have the right to get a second opinion from another doctor in your health plan about what kind of treatment your child needs.
You have the right to be treated fairly by your health plan, doctors, hospitals and other providers.

To know about the health status of child.It includes the rights to:

To talk to your child's doctors and other providers in private
To have your child's medical records kept private
To look over and copy your child's medical records and to ask for changes to those records.

If you think your doctor or the health plan was right,then the rights include:

Have the right to a fair and quick process for solving problems with your health plan and the plan's doctors, hospitals and others who provide services to your child.
If your health plan says it will not pay for a covered service or benefit that your child's doctor thinks is medically necessary, you have a right to have another group, outside the health plan

Member Responsibilities:

You and your health plan both have an interest in seeing your child's health improve. You can help by assuming these responsibilities.

Try to follow healthy habits, such as, encourage your child to exercise, to stay away from tobacco, and to eat a healthy diet.
Become involved in the doctor's decisions about your child's treatments.
Work together with your health plan's doctors and other providers to pick treatments for your child that you have all agreed upon.
If you have a disagreement with your health plan, try first to resolve it using the health plan's complaint process.
Learn about what your health plan does and does not cover. Read your Member Handbook to understand how the rules work.
If you make an appointment for your child, try to get to the doctor's office on time. If you cannot keep the appointment, be sure to call and cancel it.
To pay your doctor and other providers co-payments that you owe them.
Report misuse of CHIP by health care providers, other CHIP members, or CHIP health plans.

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