| Have to get accurate, easy-to-understand information to help you make good
choices about your child's health plan, doctors, hospitals and other providers. |
| Your health plan must tell you if they use a "limited provider network." This
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 your health plan uses "limited networks," you
should 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." |
| You have a right to know how your doctors are paid. Some get a fixed payment no
matter how often you visit. Others get paid based on the services they give to
your child. You have a right to know about what those payments are and how they
work. |
| You have a right to know how the health plan decides about whether a service is
covered and/or medically necessary. You have the right to know about the people
in the health plan who decides those things. |
| You have a right to know the names of the hospitals and other providers in your
health plan and their addresses. |
| You have a right to pick from a list of health care providers that is large
enough so that your child can get the right kind of care when your child needs
it. |
| If your child is confirmed to have special health care needs or a disability,
you may be able to use a specialist as your child's primary care provider. Ask
your health plan about this. |
| 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, your child may be able to continue seeing that doctor
for three months and the health plan must continue paying for those services.
Ask your plan about how this works. |
| 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. Ask your plan how this works. Some plans may
make you pick an OB/GYN before seeing that doctor without a referral. |
| You have a right to emergency services when you need them if you reasonably
believe your child's life is in danger, or that your child would be seriously
hurt without getting treated right away. 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." |
| You 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. |
| You have the right to talk to your child's doctors and
other providers in private, and to have your child's medical records kept
private. You have the right to look over and copy your child's medical records
and to ask for changes to those records. |
| You 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, tell you if they think
your doctor or the health plan was right. |
