Enhanced Care (Medicaid Managed Care) Member Rights and Responsibilities

 

Understanding your rights and responsibilities as a plan member can help you and us make the most of your membership. Below, we have listed your rights, or what you can expect of us, as well as your responsibilities, or what we expect from you.

As a member of EmblemHealth Enhanced Care, you have a right to:

  • Be cared for with respect, without regard for health status, sex, race, color, religion, national origin, age, marital status or sexual orientation.
  • Be told where, when and how to get the services you need from EmblemHealth Enhanced Care.
  • Be told by your PCP what is wrong, what can be done for you, and what will likely be the result in language you understand.
  • Get a second opinion about your care.
  • Give your OK to any treatment or plan for your care after that plan has been fully explained to you.
  • Refuse care and be told what you may risk if you do.
  • Get a copy of your medical record, and talk about it with your PCP, and to ask, if needed, that your medical record be amended or corrected.
  • Be sure that your medical record is private and will not be shared with anyone except as required by law, contract, or with your approval.
  • Use the EmblemHealth Enhanced Care complaint system to settle any complaints, or you can complain to the New York State Department of Health or the local Department of Social Services any time you feel you were not fairly treated.
  • Use the State Fair Hearing system.
  • Appoint someone (relative, friend, lawyer, etc.) to speak for you if you are unable to speak for yourself about your care and treatment.
  • Receive considerate and respectful care in a clean and safe environment free of unnecessary restraints.

As a member of EmblemHealth Enhanced Care, you agree to:

  • Work with your PCP to guard and improve your health.
  • Find out how your health care system works.
  • Listen to your PCP’s advice and ask questions when you are in doubt.
  • Call or go back to your PCP if you do not get better or ask for a second opinion.
  • Treat health care staff with the respect you expect yourself.
  • Tell us if you have problems with any health care staff. Call Member Services.
  • Keep your appointments. If you must cancel, call as soon as you can.
  • Use the emergency room only for real emergencies.
  • Call your PCP when you need medical care, even if it is after-hours.

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