Rights and Responsibilities
Your Member Rights
As a member of our health plan, you have the right to:
- Get information about our plan, services, doctors, and providers
- Get information about your rights and responsibilities
- Know the names and titles of doctors and other health providers caring for you
- Be treated with respect and dignity
- Confidentiality and nondiscrimination
- Have your privacy protected
- Have a reasonable opportunity to choose your PCP and to change to another provider in a reasonable manner
- Agree to or refuse treatment and actively participate in making decisions
- Decide with your doctor on the care you get
- Talk openly about care you need for your health, no matter the cost or benefit coverage, and the choices and risks involved (this information must be given in a way you understand)
- Timely access to care that does not have any communication or physical access barriers
- Have the risks, benefits and side effects of medications and other treatments explained to you
- Know about your health care needs after you get out of the hospital or leave the doctor’s office
- Refuse care, as long as you agree to be responsible for your decision
- Refuse to take part in any medical research
- Complain about our plan or the care we provide; also, to know that if you do, it will not change how you’re treated
- Not be responsible for our debts in the event of bankruptcy and not be held liable for:
- Payments of covered services provided under a contract, referral or other arrangement to the extent that those payments are in excess of the amount you would owe if we provided the services directly
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation
- Ask for and get a copy of your medical records from your doctor in accordance with applicable federal and state law; also, to ask that the records be changed/corrected if needed
- Requests must be received in writing from you or the person you choose to represent you
- The records will be provided at no cost
- They will be sent within 14 days of receipt of the request
- Timely referral and access to medically needed specialty care
- Have your records kept private
- Make your health care wishes known through advance directives
- Prepare advance medical directives
- Have a say in our member rights and responsibilities policy
- Use our grievance process to file a grievance, get help with filing an appeal, and get a hearing from us and/or the State
- Appeal medical or administrative decisions by our or the State’s appeal process
- Exercise these rights no matter your sex, age, race, ethnicity, income, education or religion
- Have our staff observe your rights
- Have all of the above rights apply to the person legally able to make decisions about your health care
- Be furnished quality services, which include:
- Accessibility
- Authorization standards
- Availability
- Coverage
- Coverage outside of network
- The right to a second opinion
- You also have the right to ask for more information about:
- Our structure and operation
- Our physician incentive plan
- Our service utilization policies
- How to report alleged marketing violations to Medicaid and Long-Term Care (MLTC)
- Reports to the State about transactions between WellCare of Nebraska and other parties
Your Member Responsibilities
As a member of our health plan, you have the responsibility to:
- Know your member rights
- Offer information that we and your providers need to give care
- Follow WellCare of Nebraska’s and MLTC’s policies and procedures
- Learn about your care and treatment options
- Actively participate in personal health and care decisions, and practice healthy lifestyles
- Report suspected fraud, waste and abuse
- Follow plans and instructions for care that you have agreed on with your doctor
- Understand your health problems
- Help set treatment goals that you and your doctor agree to
- Read your member handbook to understand how our health plan works
- Carry your WellCare of Nebraska member ID card at all times
- Carry your Medicaid ID card at all times
- Show your ID cards to each provider
- Schedule appointments for all non-emergency care through your PCP
- Get a referral from your PCP when appropriate
- Cooperate with the people who provide your health care
- Be on time for appointments
- Tell the doctor’s office if you need to cancel or change an appointment
- Respect the rights of all providers
- Respect the property of all providers
- Respect the rights of other patients
- Not be disruptive in your doctor’s office
- Know the medicines you take, what they are for, and how to take them the right way
- Make sure your PCP has copies of all previous medical records
- Let us know within 48 hours, or as soon as possible, if you are admitted to the hospital or get emergency room care
- Be responsible for cost sharing only as specified under covered services co-payments
Tell WellCare of Nebraska immediately if you have an accident at work, car accident or are involved in a personal injury or malpractice lawsuit, or accident of any kind.