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Members

Member Rights & Responsibilities

Doctor and Patient
Each Medicaid Managed Care Organization (MCO) member is guaranteed the following rights:
  1. To receive information about your member rights and responsibilities;
  2. To make recommendations to Molina Healthcare of South Carolina about these member rights and responsibilities;
  3. To be treated with respect and with due consideration for your dignity and privacy;
  4. To participate in decisions regarding your health care, including the right to refuse treatment;
  5. To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in the federal regulations on the use of restraints and seclusion;
  6. To be able to request and receive a copy of your medical records, and request that they be amended or corrected;
  7. To receive health care services that are accessible, are comparable in amount, duration, and scope to those provided under Medicaid FFS, and are sufficient in amount, duration, and scope to reasonably be expected to achieve the purpose for which the services are furnished;
  8. To have a candid discussion of appropriate or medically necessary treatment options for your condition regardless of cost or benefit coverage;
  9. To receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness, or medical condition;
  10. To receive all information, including but not limited to, enrollment notices, informational materials, instructional materials, available treatment options, and alternatives in a manner and format that may be easily understood;
  11. To receive assistance from both SCDHHS and Molina Healthcare of South Carolina in understanding the requirements and benefits of the Molina Healthcare of South Carolina's plan;
  12. To receive oral interpretation services free of charge for all non-English languages, not just those identified as prevalent;
  13. To be notified that oral interpretation is available and how to access those services;
  14. As a potential member, to receive information about the basic features of managed care, which populations may or may not enroll in the program and the MCO's responsibilities for coordination of care in a timely manner in order to make an informed choice;
  15. To receive information on Molina Healthcare of South Carolina's services, to include, but not limited to:
    1. Benefits covered;
    2. Cost-sharing requirements;
    3. Procedures for obtaining benefits, including any authorization requirements;
    4. Service area
    5. Names, locations, telephone numbers of non-English language spoken by current contracted providers, including at a minimum, primary care physicians, specialists, and hospitals;
    6. Any restrictions on member's freedom of choice among network providers;
    7. Providers not accepting new patients; and
    8. Benefits not offered by Molina Healthcare of South Carolina but available to members and how to obtain those benefits, including how transportation is provided.
  16. To receive a complete description of disenrollment rights at least annually;
  17. To receive notice of any significant changes in the Benefits Package at least thirty (30) days before the intended effective date of the change;
  18. To receive information on the Appeal, Grievance, and State Fair Hearing procedures including the right to file;
  19. To be able to file an appeal, a grievance (complaint) or request a State Fair Hearing;
  20. To receive detailed information on emergency and after-hours coverage, to include, but not limited to:
    1. What constitutes an emergency medical condition, emergency services, and Post Stabilization services;
    2. Emergency services do not require Prior Approval;
    3. The process and procedures for obtaining emergency services;
    4. The locations of any emergency settings and other locations at which providers and hospitals provide;
    5. Emergency services and Post Stabilization services covered under the contract. Your right to use any hospital or other setting for emergency care; and
    6. Post Stabilization care services.
  21. To receive Molina Healthcare of South Carolina's policy on referrals for specialty care and other benefits not provided by your primary care provider;
  22. To have your privacy protected in accordance with the privacy requirements in the Code of Federal Regulations (45 CFR, 160, 164 (A)(E)), to the extent that they are applicable; and
  23. To exercise these rights without adversely affecting the way Molina Healthcare of South Carolina, its providers, or SCDHHS treats the members.

As a member of Molina Healthcare of South Carolina, you have the responsibility:
  1. To provide information to your doctor that is needed to make decisions about your health care;
  2. To be active in decisions about your health care;
  3. To follow the care plans and instructions that you have agreed upon with your doctor(s);
  4. To build and keep a strong patient-doctor relationship, you have the responsibility to cooperate with your doctor and staff. This includes being on time for your visits or calling your doctor if you need to cancel or reschedule an appointment;
  5. To present your Molina Healthcare of South Carolina ID card and state ID card when receiving medical care;
  6. To report any fraud or wrongdoing to Molina Healthcare of South Carolina or the proper authorities;
  7. To understand your health problems and participate in developing mutually agreed-upon treatment goals;
  8. To contact South Carolina Healthy Connections at (888) 549-0820, TTY/TDD: (888) 842-3620 to report any change of address, family size, living arrangements, or county of residence;
  9. To inform Molina Healthcare of South Carolina of the loss or theft of your member ID card(s);
  10. To be familiar with Molina Healthcare of South Carolina's procedures to the best of your ability;
  11. To contact Molina Healthcare of South Carolina if you need information or have any questions about your care;
  12. To access and use preventive care services;
  13. Non-Discrimination of Caregivers - you must not discriminate against your caregivers because of race, color, national origin, religion, sex, ancestry, marital status, physical or mental disability, unfavorable military discharge, or age. To do so is a Federal offense; and
  14. To keep your health plan, you must renew your SC Healthy Connections coverage every year. You will receive a redetermination packet from SCDHHS at least 60 days before your coverage ends. If you do not receive your packet, call SCDHHS at (888) 549-0820, TTY/TDD: (888) 842-3620. Molina members, if you have questions, call Molina at (855) 882-3901 or call Healthy Connections at (888) 549-0820, TTY/TDD: (888) 842-3620 to help renew your benefits.

 

 

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This information is for Doctors and
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