Members

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:

Your Membership Rights

  1. To be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her 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 his or her care.
  5. To know what patient support services are available, including whether an interpreter is available if he or she does not speak English.
  6. To know what rules and regulations apply to his or her conduct.
  7. To be given by health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.
  8. 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.
  9. 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.
  10. To request and receive a copy of his or her medical records, and request that they be amended or corrected.
  11. To be furnished health care services in accordance with federal and state regulations.
  12. To refuse any treatment, except as otherwise provided by law.
  13. To be given, upon request, full information and necessary counseling on the availability of known financial resources for his or her care.
  14. 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.
  15. To receive, upon request, prior to treatment, a reasonable estimate of charges for medical care.
  16. To receive a copy of reasonably clear and understandable, itemized bill and, upon request, to have the charges explained.
  17. To impartial access to medical treatment or accommodations, regardless of race, national origin, religion, physical handicap, or source of payment.
  18. To treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
  19. To know if medical treatment is for purposes of experimental research and to give his or her consent or refusal to participate in such experimental research.
  20. To receive information about Molina Healthcare, its services, its practitioners and providers and members’ right and responsibilities.
  21. To request and obtain information on any limits of your freedom of choice among network providers
  22. To receive information about the structure and operation of Molina.
  23. To make recommendations about Molina Healthcare’s member rights and responsibilities policies.
  24. To voice complaints or appeals about the organization or the care it provides.
  25. To express grievance regarding any violation of his or her rights, through the grievance procedure of the health care provider or health care facility which served him or her and to the appropriate state licensing agency listed below.

 

Office of Civil Rights
United States Department of Health and Human Services
Sam Nunn Atlanta Federal Center, Suite 16T70
Atlanta, GA 30303-8909
Voice Phone (800) 368-1019
FAX (404) 562-7881
TDD (800) 537-7697

 

Your Membership Responsibilities

As a member of Molina Healthcare, you agree to:

  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 reporting unexpected changes in your condition to the health care provider.
  3. 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.
  4. To follow the care plan that you have agreed on with your provider.
  5. 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.
  6. For his or her actions if he or she refuses treatment or does not follow the health care provider’s instructions.
  7. For assuring that the financial obligations of his or her health care are fulfilled as promptly as possible.
  8. For following health care facility rules and regulations affecting patient care and conduct.
  9. To understand your health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.
  10. 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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