Rights & Responsibilities
Member Rights & 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:
- To be treated with courtesy and respect, with appreciation of your individual dignity, and with protection of your need for privacy.
- To request and obtain information on any limits of your freedom of choice among network providers.
- To a prompt and reasonable response to questions and requests.
- To know who is providing medical services and who is responsible for your care.
- To know what patient support services are available, including whether an interpreter is available if you do not speak English.
- To know what rules and regulations apply to your conduct.
- To receive information in a manner and format that may be easily understood.
- To be given, by a 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.
- To be able to take part in decisions about your health care.
- To have an open discussion about your medically necessary treatment options for your conditions, regardless of cost or benefit.
- 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.
- To request and receive a copy of your medical records, and request that they be amended or corrected.
- To request disenrollment.
- To be furnished health care services in accordance with federal and state regulations.
- To refuse any treatment, except as otherwise provided by law.
- To be given, upon request, full information, and necessary counseling on the availability of known financial resources for your care.
- 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.
- To receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
- To receive a reasonably clear and understandable itemized bill
- To have your bill and medical charges explained, upon request.
- To impartial access to medical treatment or accommodations, regardless of race, national origin, religion, disability, or source of payment.
- To treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
- To know if medical treatment is for purposes of experimental research and to give your consent or refusal to participate in such experimental research.
- To receive information about Molina Healthcare, its services, its practitioners and providers and members’ rights and responsibilities.
- To exercise these rights without an adverse effect in the way Molina and its Providers treat you.
- To receive information about the structure and operation of Molina.
- To make recommendations about Molina Healthcare’s member rights and responsibilities policies.
- To voice complaints or appeals about the organization or the care it provides.
- 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.
Nebraska Department of Health and Human Services MLTC Appeal Coordinator
PO Box 94967
Lincoln, NE 68509-4967
You are responsible:
- 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 your health.
- For the cost of unauthorized services obtained from non-participating providers.
- For reporting unexpected changes in your condition to the health care provider.
- For reporting to the health care provider whether you comprehend a contemplated course of action and what is expected of you.
- To follow the care plan that you have agreed on with your provider.
- For keeping appointments and, when you are unable to do so for any reason, to notify the health care provider or healthcare facility.
- For your actions if you refuse treatment or do not follow the health care provider’s instructions.
- For assuring that the financial obligations of your health care are fulfilled as promptly as possible.
- For following health care facility rules and regulations affecting patient care and conduct.
- To understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.
- 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.)
*You may request printed copies of all content posted on our website.