Rights and Responsibilities

Your Member Rights

• 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.