Member Rights and Responsibilities
As a member, you have the right to:
- Be treated with respect and recognition of your dignity by everyone who works with Molina Healthcare.
- Get information about Molina Healthcare, our providers, our doctors, and our services. This includes how Molina Healthcare pays your providers for your medical care, our organizational structure, policies and procedures, practice guidelines, physician incentives and how to recommend changes.
- Be informed about your health. If you have an illness, you have the right to candid discussion regarding treatment options, regardless of cost or benefit coverage. Members have the right to have all questions about their health answered.
- Help make decisions about your health care. You have the right to refuse medical treatment.
- Privacy. Molina Healthcare keeps your medical records private. (Subject to State and Federal laws.)
- See your medical record, including the results of your Wellness Assessment. You also have the right to get a copy of and/or correct your medical record where legally okay. (Subject to State and Federal laws.)
- Complain about Molina Healthcare or their care. You can call, fax, email or write to Molina Healthcare’s Member Services.
- Appeal Molina Healthcare’s decisions. You have the right to have someone speak for you during your grievance.
- Ask for a State Fair Hearing by contacting APS@dhw.idaho.gov. You also have the right to get information on how to get an expedited State Fair Hearing quickly.
- Disenroll from Molina Healthcare (Leave the Molina Healthcare Health Plan.).
- Ask for a second opinion about your health condition.
- Ask for someone outside Molina Healthcare to look into therapies that are experimental or being done as part of exploration.
- Decide in advance how you want to be cared for in case of a life-threatening illness or injury.
- Get interpreter services on a 24-hour basis, at no cost, to help you talk with your doctor or us if they prefer to speak a language other than English.
- Not be asked to bring a minor, friend, or family member with you to act as your interpreter.
- Get information about Molina Healthcare, your providers, or your health in the language you prefer.
- Ask for and get materials in other formats such as larger size print, audio, and Braille upon request and in a timely fashion appropriate for the format being requested and in accordance with state laws. You may request printed copies of all content posted on our website.
- Receive instructions on how you can view online, or request a copy of Molina Healthcare’s non-proprietary clinical and administrative policies and procedures.
- Get a copy of Molina Healthcare’s list of approved drugs (drug formulary) on request.
- Submit a grievance if you did not get medically needed medications after an emergency visit at one of Molina Healthcare’s contracted hospitals.
- Access family planning services, Federally Qualified Health Centers, Indian Health Facilities, sexually transmitted disease services, and Emergency services, outside of Molina Healthcare’s network according to federal laws. You do not need to get Molina Healthcare’s approval first.
- Get minor consent services.
- Not be treated poorly by Molina Healthcare, your doctors or the Department of Health Care Services for acting on any of these rights.
- Make recommendations regarding the organization’s member rights and responsibilities policies.
- Be free from controls or isolation used to pressure, punish or seek revenge.
- File a grievance or complaint if you believe your linguistic needs were not met by the plan.
As a member, you have the responsibility to:
- Learn and ask about your health benefits. If you have a question about your benefits, call toll-free (844) 809-8445.
- Give information to your doctor, provider, or Molina Healthcare needed to care for you.
- Be active in decisions about your health care.
- Follow the care plans and instructions for care that you have agreed on with your doctor(s).
- Build and keep a strong patient-doctor relationship. You have the responsibility to cooperate with your doctor and staff, keep appointments, and be on time. If you are going to be late or cannot keep your appointment, you should call your doctor’s office.
- Give your medical ID card when getting medical care. You have the responsibility to not give your card to others and let Molina Healthcare or the State know about any fraud or wrongdoing.
- Understand your health problems and participate in developing mutually agreed-upon treatment goals as you are able.
*You may request printed copies of all content posted on our website.