Members' Rights and Responsibilities

Molina Medicare’s Dual Options Plan members have certain rights to help protect them. In this chapter, Member rights and responsibilities are outlined based on Molina Medicare of Michigan’ Evidence of Coverage document that members receive annually.

Molina Dual Options Plan Members have a right to:

  1. Members have the right to be treated with respect and recognition of their dignity by everyone who works with and for MHI Molina Dual Options program
  2. Members have the right to receive information about MHI Molina Dual Options program, covered benefits, our providers, our doctors, our services and member's rights and responsibilities
  3. Members have the right to choose their primary care physician (PCP) that gives care whenever possible and appropriate from Molina Dual Options network and the provision to change PCP on the Molina Dual Options network at least monthly. Molina Dual Options program must communicate all changes in writing as to who the new PCP is and the effective date of change
  4. Members have the right to receive and/or to authorize representative(s) to obtain information about their health in simple and understandable terminology and/or nominate contact(s) to be reached in case of emergency. If members are ill, members have the right to be told about treatment options regardless of cost or benefit coverage. Members have the right to have all questions about their health answered.
  5. Members have the right to help make decisions about their health care. Members have the right to refuse medical treatment. In case of such refusals, the provider or MHI must be able to provide information about the consequences of refusal of treatment as well as document the details in the medical records.
  6. Members have the right to privacy. MHI, its Staff and affiliates keeps their medical records private in accordance with State and Federal laws.
  7. Members have the right to see their medical record. Members have the right to receive a copy of their medical records, and request that they be amended or corrected, as specified in 45 CFR §164.524 and 164.526.
  8. Members have the right to complain about MHI Molina Duals Options program or their care by calling, faxing, e-mailing or writing to Molina Duals Options Member Services Department.
  9. Members have the right to appeal MHI Molina Duals Options decisions. Members have the right to have someone speak for them during the grievance.
  10. Members have the right to disenroll from MHI Molina Dual Options
  11. Members have the right to ask for a second opinion about their health condition from a qualified provider on Molina Healthcare’s plan. If the qualified provider is not able to provide service to member, MHI Molina Duals Options must set up a visit with a provider not on our panel. These services are available at no extra cost to member.
  12. Members have the right to ask for an external independent review of experimental or investigational therapies
  13. Members have the right to decide in advance directives (a living will) on how they want to be cared for in case they have a life-threatening illness or injury
  14. Members have the right to participate in decisions regarding his or her health care, including the right to refuse treatment.
  15. Members have the right to receive interpreter services at no cost to help them talk with their doctor or MHI Molina Duals Options interpreter if they prefer to speak a language other than English and get help with sign language if hearing impaired.
  16. Members have the right to not be asked to bring a friend or family member with them to act as their interpreter
  17. Members have the right to receive information about the MHI Molina Duals Options program, their providers, or their health in their preferred language free of charge. Members have the right to request information in printed form translated into their preferred language.
  18. Members also have the right to request and receive informational materials in alternative formats (including Braille, large size print, and audio format) upon request and in a timely fashion appropriate for the format being requested at no cost to member.
  19. Members have the right to receive a copy of MHI Molina Duals Options program drug formulary on request.
  20. Members have the right to access minor consent services
  21. Members have the freedom to exercise these rights without negatively affecting how they are treated by MHI Molina Duals Options program staff, its providers, consistent with CMS and regulations for those states that are participating in the MMP demonstration plan. There are disciplinary procedures for staff members who violate this policy.
  22. Members have a right to make recommendations regarding the organization's member rights and responsibilities policies
  23. Members have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation
  24. Members have the right to file a grievance or complaint if they believe their linguistic needs were not met by the plan.
  25. Members have the right to receive instructions on how they can view online, or request a copy of MHI Molina Duals Options program non-proprietary clinical and administrative policies and procedures.
  26. Female members should be able to go to a women’s health provider on MHI Molina Duals Options panel for covered Women’s health services.
  27. MHI Molina Duals Options program’s staff and its providers will not discriminate against enrollees due to Medical condition (including physical and mental illness) or for any of the following: claims experience, receipt of health care, medical history, genetic information, evidence of insurability, or disability.
  28. Members have the right to contact the United States Department of Health and Human Services Office of Civil Rights and/or their local office for Civil Rights with any complaints of discrimination based on race, color, religion, sex, sexual orientation, age, disability, national origin, veteran’s status, ancestry, health status, or need for health services.
  29. Members have the right to reasonable accommodation in order to access care.

 

In addition, MHC Molina Dual Options members have the right to:

  1. Request a State Fair Hearing by calling (800) 952-5253. Members also have the right to receive information on the reason for which an expedited State Fair Hearing is possible
  2. Receive family planning services, treatment for any sexually transmitted disease, emergency care services, from Federally Qualified Health Centers and/or Indian Health Services without receiving prior approval and authorization from MHC

 

Molina Medicare Members have a responsibility to:

  1. Members have the responsibility to be familiar with and ask questions about their health benefits. If Members have a question about their benefits, they may call MHI Molina Duals Options Member Services Department.
  2. Members have the responsibility to provide information to their doctor or MHI Molina Duals Options staff that is needed to care for them.
  3. Members have the responsibility to be active in decisions about their health care
  4. Members have the responsibility to understand their health conditions and work with their provider to develop treatment goals and follow the care plans and instructions for care that they have agreed on with their doctor(s).
  5. Members have the responsibility to build and keep a strong patient-doctor relationship. Members have the responsibility to cooperate with their doctor and staff. This includes being on time for their visits or calling their doctor if they need to cancel or reschedule an appointment. Members are expected to call their provider 24 hours in advance if they are going to be late or cannot keep their appointment.
  6. Members have the responsibility to present their MHI Molina Duals Options ID and State card when receiving medical care and report any fraud or wrongdoing to MHI or the proper authorities. In addition, not let anyone else uses their Healthcare ID card.
  7. Members have a responsibility to understand their health problems and participate in developing mutually agreed-upon treatment goals to the degree possible.
  8. Call MHI Molina Duals Options staff within 24 hours of a visit to the emergency department or an unexpected stay in the hospital.
  9. Inform MHI Molina Duals Options staff if they would like to change their PCP and MHI Molina Duals Options will verify that the PCP selected is contracted with MHI Molina Duals Options program and is accepting new patients
  10. Inform MHI Molina Duals Options staff and their county case worker in case of change of name address or telephone number or if there are any changes that could affect their eligibility.
  11. Let MHI Molina Duals Options staff and your health care provider know if they or any of their family members have other health insurance coverage.

 

In addition, MHC Molina Dual Options have the responsibility to:
Inform the Member Services Department of any change of address or any changes to entitlement that could affect continuing eligibility.