Member Rights and Responsibilities

Your Rights

Knowing About Physician Incentive Plan

You have the right to ask if we have special financial arrangements with our physicians that can affect the use of referrals and other services you might need. To get this information, call our Customer Service Department at 1-888-713-6180 and request information about our physician payment arrangements.

Knowing Provider Credentials

You have the right to information about our providers including the provider’s education, board certification, and recertification. To get this information, call our Customer Service Department at 1-888-713-6180.

Completing an Advance Directive, Living Will, Or Power Of Attorney for Health Care

You have the right to make decisions about your medical care. You have the right to accept or refuse medical or surgical treatment. You have the right to plan and direct the types of health care you may get in the future if you become unable to express your wishes. You can let your doctor know about your wishes by completing an advance directive, living will, or power of attorney for health care. Contact your doctor for more information.

You have the right to file a grievance with the DHS Division of Quality Assurance if your advance directive, living will, or power of attorney wishes are not followed. You may request help in filing a grievance.

Right to Medical Records

You have the right to ask for copies of your medical records from your provider(s). We can help you get copies of these records. Please call 1-888-713-6180 for help. Please note that you may have to pay to copy your medical records. You may correct inaccurate information in your medical records if your doctor agrees to the correction.

Moral or Religious Objection

The health plan will inform members of any covered Medicaid benefits which are not available through the HMO because of an objection on moral or religious grounds. The health plan will inform members about how to access those services through the State.

Your Member Rights

• You have the right to have an interpreter with you during any BadgerCare Plus or Medicaid SSI covered service.
• You have the right to get the information provided in this member handbook in another language or format.
• You have the right to get health care services as provided for in federal and state law. All covered services must be available and accessible to you. When medically appropriate, services must be available 24 hours a day, seven days a week.
• You have a right to a candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
• You have the right to participate with practitioners in making decisions about your health care.
• You have the right to be treated with respect and recognition of your dignity and right to privacy.
• You have the right to be free from any form of restraint or seclusion used as a means of force, control, ease, or reprisal.
• You have the right to be free to exercise your rights without adverse treatment by the HMO and its network providers.
• You may switch HMOs without cause during the first 90 days of enrollment.
• You have the right to switch HMOs, without cause, if the State imposes sanctions or temporary management on this health plan.
• You have the right to receive information from this health plan regarding any significant changes with the health plan at least 30 days before the effective date of the change.
• You have a right to receive information about this health plan, its services, its practitioners and providers and member rights and responsibilities.
• You have a right to voice complaints or appeals about the organization or the care it provides.
• You have a right to make recommendations regarding the organization’s member rights and responsibilities policy.

Your Responsibilities

• You have a responsibility to supply information (to the extent possible) that the organization and its practitioners and providers need in order to provide care.
• You have a responsibility to follow plans and instructions for care that they have agreed to with their practitioners.
• You have a responsibility to understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.

You have the right to disenroll from the HMO if:

• You move out of the HMO/PIHP’s service area
• Your HMO/PIHP does not, for moral or religious objections, cover a service you want
• You need a related service performed at the same time, not all related services are available within the provider network, and your PCP or another provider determines that receiving the services separately could put you at unnecessary risk
• Other reasons, including poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with your care needs.

Your Civil Rights

MHS Health Wisconsin provides covered services to all eligible members regardless of the following:

• Age
• Color
• Disability
• National origin
• Ethnicity
• Race
• Sex
• Gender identity
• Sexual orientation
• Religion
• Marital status

All medically necessary covered services are available and will be provided in the same manner to all members. All persons or organizations connected with this health plan that refer or recommend members for services shall do so in the same manner for all members.