Member Rights and Responsibilities
What are my Rights?
- You have the right to:
- Be treated fairly and with respect and recognition on your dignity by everyone who works with Molina Healthcare.
- Get information about Molina Healthcare, our providers, our doctors, our services and member’s rights and responsibilities.
- Choose your “main” doctor from Molina Healthcare’s network. (This doctor is called a primary care doctor or personal doctor).
- Be informed about your health. If you have an illness, you have the right to be told about treatment options regardless of cost or benefit coverage.
- You have the right to have all questions about your 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.*
- See your medical record, including the results of your Initial Health Assessment (IHA). You also have the right to get a copy of and or correct your medical record where legally okay.*
- 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 calling toll-free (801) 538-6576. You also have the right to get information on how to get an expedited State Fair Hearing quickly.
- 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 you have 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 you prefer to speak a language other than English.
- Not be asked to bring minor, friend, or family member with you to act as their interpreter.
Get information about Molina Healthcare, their 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.
- 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 medication 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 to be treated poorly by Molina Healthcare, their doctors or the Department of Health 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.
*Subject to State and Federal laws.
What are my Responsibilities?
- Your responsibilities are:
- To learn and ask about their health benefits. If you have a question about your benefits, call toll-free (888) 483-0760.
- To give information to your doctor, provider, or Molina Healthcare that is needed for your care.
- To be active in decisions about your health care.
- To follow the care plans and instructions for care that you have agreed on with your doctor(s).
- To build a keep a strong patient-doctor relationship.
- 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.
- To give your State Medicaid ID card when getting medical care and to not give their card to others. Let Molina Healthcare or the State know about any fraud or wrongdoing.
- To understand your health problems and participate in developing mutually agreed-upon treatment goals
If you have any problem reading or understanding this or any Molina Healthcare information, call Member Services at (888) 483-0760. We can explain in English or in your primary language. You may request printed versions of these materials and they will be sent to you free of charge and within five business days. We may have it printed in other languages. You may ask for it in braille, large print, or audio. If you are hearing impaired, dial 711 for the Utah Relay Service