Member Rights & Responsibilities

rights

Your Member Rights and Responsibilities

Did you know that as a member of Molina Healthcare, you have certain rights and responsibilities? Knowing your rights and responsibilities will help you, your family, your provider and Molina Healthcare ensure that you get the covered services and care that you need. 

You have the right to:

  1. To be treated with courtesy and respect, with appreciation of your individual dignity, and with protection of your need for privacy
  2. To request and obtain information on any limits of your freedom of choice among network providers
  3. To a prompt and reasonable response to questions and requests
  4. To know who is providing medical services and who is responsible for your care
  5. To know what patient support services are available, including whether an interpreter is available if you do not speak English
  6. To know what rules and regulations apply to your conduct
  7. Receive information in a manner and format that may be easily understood
  8. To be given by health care provider information concerning diagnosis, planned course of treatment, treatment options, alternatives, risks, and prognosis in a manner appropriate to your condition and ability to understand
  9. To be able to take part in decisions about your health care
  10. To have an open discussion about your medically necessary treatment options for your conditions, regardless of cost or benefit
  11. To be free from any form of restraint or seclusion used as means of coercion, discipline, convenience, or retaliation, as specified in other Federal regulations on the use of restraints and seclusion
  12. To request and receive a copy of your medical records, and request that they be amended or corrected
  13. To be furnished health care services in accordance with federal and state regulations
  14. To refuse any treatment, except as otherwise provided by law
  15. To be given, upon request, full information, and necessary counseling on the availability of known financial resources for your care
  16. If you are eligible for Medicare, to know, upon request and in advance of treatment, whether the health care provider or health care facility accepts the Medicare assignment rate
  17. To receive, upon request, prior to treatment, a reasonable estimate of charges for medical care
  18. To receive a copy of reasonably clear and understandable, itemized bill and, upon request, to have the charges explained
  19. To impartial access to medical treatment or accommodations, regardless of race, national origin, religion, physical handicap, or source of payment
  20. To treatment for any emergency medical condition that will deteriorate from failure to provide treatment
  21. To know if medical treatment is for purposes of experimental research and to give your consent or refusal to participate in such experimental research
  22. To receive information about Molina Healthcare, its services, its practitioners and providers and members’ right and responsibilities
  23. To request and obtain information on any limits of your freedom of choice among network providers
  24. Free exercise of rights and the exercise of those rights do not adversely affect the way the Molina and its Providers treat you.
  25. To receive information about the structure and operation of Molina
  26. To make recommendations about Molina Healthcare’s member rights and responsibilities policies
  27. To voice complaints or appeals about the organization or the care it provides
  28. To express grievance regarding any violation of your rights, through the grievance procedure of the health care provider or health care facility which served you and to the appropriate state licensing agency listed below

Mississippi Division of Medicaid
550 High Street, Suite 1000
Jackson, MS 39201
Phone: 1-(800) 421-2408 (Deaf and Hard of Hearing dial: 711)

 

You are responsible: 

  1. For providing to the health care provider, to the best of your knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters relating to his or her health.
  2. For the cost of unauthorized services obtained from non-participating providers. 
  3. For reporting unexpected changes in your condition to the health care provider.
  4. For reporting to the health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.
  5. To follow the care plan that you have agreed on with your provider.
  6. For keeping appointments and, when he or she is unable to do so for any reason, to notify the health care provider or healthcare facility.
  7. For his or her actions if he or she refuses treatment or does not follow the health care provider’s instructions.
  8. For assuring that the financial obligations of his or her health care are fulfilled as promptly as possible.
  9. For following health care facility rules and regulations affecting patient care and conduct.
  10. To understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.
  11. To report truthful and accurate information when applying for Medicaid. (You will be responsible to repay capitation premium payments if your Enrollment is stopped due to failure to report truthful or accurate information.)


 

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