Member Rights and Responsibilities
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.
HMO Moral or Religious Objection
The HMO will inform members of any covered Medicaid benefits which are not available through the HMO because of an objection on moral or religious grounds. MHS Health 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 and/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 the right to get information about treatment options including the right to request a second opinion.
- You have the right to make decisions about your health care.
- You have the right to be treated with dignity and respect.
- 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 with MHS Health.
- You have the right to switch HMOs, without cause, if the State imposes sanctions or temporary management on MHS Health.
- You have the right to receive information from MHS Health regarding any significant changes with MHS Health at least 30 days before the effective date of the change.
Your Civil Rights
MHS Health provides covered services to all eligible members regardless of the following:
- National origin
- Health status
- Gender identification
- Sexual orientation
All medically necessary covered services are available and will be provided in the same manner to all members. All persons or organizations connected with MHS Health that refer or recommend members for services shall do so in the same manner for all members.
Fraud and Abuse
If you suspect fraud or abuse of the Medicaid program, you may report it. Please go to www.reportfraud.wisconsin.gov.