Rights and Responsibilities
Decisions about your health care
Maryland Physicians Care wants to tell you about your rights as a member. We also want to tell you our policies about those rights. Please take a minute to read this. It is a summary about your health care. Your provider should tell you how he or she plans to treat you. The provider should tell you if other treatments can be used and the risks for each one. Make sure your decisions about your medical care are followed. You may want to put the decisions in writing before you get treatment.
YOU HAVE THE RIGHT TO:
- Receive health care and services that are culturally competent and free from discrimination.
- Be treated with respect to your dignity and privacy.
- Receive information, including information on treatment options and alternatives, regardless of cost or benefit coverage, in a manner you can understand.
- Participate in decisions regarding your healthcare, including the right to refuse treatment.
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation.
- Request and receive a copy of your medical records and request that they be amended or corrected as allowed.
- Request copies of all documents, records, and other information free of charge, that was used in an adverse benefit determination.
- Exercise your rights, and that the exercise of those rights does not adversely affect the way the Managed Care Organizations (MCO), their providers, or the Maryland Department of Health treat you.
- File appeals and grievances with a Managed Care Organization.
- File appeals, grievances and State fair hearings with the State.
- Request that ongoing benefits be continued during an appeal or state fair hearing however, you may have to pay for the continued benefits if the decision is upheld in the appeal or hearing. Receive a second opinion from another doctor within the same MCO, or by an out of network provider if the provider is not available within the MCO, if you do not agree with your doctor’s opinion about the services that you need. Contact your MCO for help with this.
- Receive other information about how your Managed Care Organization is managed including the structure and operation of the MCO as well as physician incentive plans. You may request this information by calling your Managed Care Organization.
- Receive Information about the services provided by your Managed Care Organization including information about practitioners and providers within its network and member rights and responsibilities.
- Make recommendations regarding the organization’s member rights and responsibilities policy.
YOU HAVE THE RESPONSIBILITY TO:
- Read this handbook, it will explain how to use your health plan to get services and should answer most of your questions.
- Follow Maryland Physicians Care’s rules.
- Pick a Primary Care Provider who participates with Maryland Physicians Care.
- Make and keep all appointments with your provider.
- If you need to cancel appointments, it must be done at least 24 hours before your scheduled visit.
- Show your Maryland Physicians Care Identification Card to each provider before getting health services.
- Make sure that the person’s name that is printed on the Maryland Physicians Care Identification Card is the only one using the card for health care services.
- Get approval from your Primary Care Physician before you get treatment from other providers. This does not include self-referral services or emergency treatment.
- Give all information about your health to Maryland Physicians Care and your Primary Care Provider. This includes immunization records for members under age 21.
- When discussing your health, if there is anything you do not understand tell your Primary Care Provider.
- Follow what your Primary Care Provider tells you. Make follow-up appointments.
- Take all medicines as prescribed and follow your Primary Care Provider’s care instructions.
- Schedule wellness check-ups. (Members under 21 years of age need to follow the Healthy Kids schedule)
- Get care as soon as you know you are pregnant. Keep all prenatal appointments.
- Use the Emergency Room (ER) for true emergencies only.
- Tell Maryland Physicians Care and the Department of Social Services (DSS) when your address changes.
- Tell the Department of Social Services about changes in your family that may affect eligibility or enrollment.
- Tell Maryland Physicians Care if you have other health insurance, including Medicare.
- Give your Primary Care Provider a copy of your living Will and Advance Directive if you have one.
- Report suspected Fraud and/or Abuse.