Rights & Responsibilities

Member Rights and Responsibilities

Apple Health (AH) and Integrated Managed Care (IMC) Member Rights

  • Help make decisions about your health care, including mental health and substance use disorder services and refusing treatment
  • Be informed about all treatment options available, regardless of cost
  • Change primary care providers
  • Get a second opinion from another provider in your health plan
  • Get services without having to wait too long
  • Be treated with respect and dignity. Discrimination is not allowed. No one can be treated differently or unfairly because of his or her race, color, national origin, gender, sexual preference, age, religion, creed, or disability.
  • Speak freely about your health care and concerns without any bad results
  • Have your privacy protected and information about your care kept confidential
  • Ask for and get copies of your medical records
  • Ask for and have corrections made to your medical records when needed
  • Ask for and get information about:   
    • Your health care and covered services   
    • Your provider and how referrals are made to specialists and other providers   
    • How we pay your providers for your medical care   
    • All options for care and why you are getting certain kinds of care   
    • How to get help with filing a grievance or complaint about your care or help in asking for a review of a denial of services or an appeal   
    • Our organizational structure including policies and procedures, practice guidelines, and how to recommend changes
  • Receive plan policies, benefits, services and Members’ Rights and Responsibilities at least yearly
  • Receive a list of crisis phone numbers
  • Receive help completing mental or medical advance directive forms

Apple Health (AH) and Integrated Managed Care (IMC) Member Responsibilities

  • Help make decisions about your health care, including refusing treatment
  • Keep appointments and be on time. Call your provider’s office if you are going to be late or if you have to cancel the appointment.
  • Give your providers information they need to be paid for providing services to you
  • Bring your Services Card and health plan ID card to all of your appointments
  • Learn about your health plan and what services are covered
  • Use health care services when you need them
  • Know your health problems and take part in agreed-upon treatment goals as much as possible
  • Give your providers and Molina Healthcare complete information about your health
  • Follow your provider’s instructions for care that you have agreed to
  • Use health care services appropriately. If you do not, you may be enrolled in the Patient Review and Coordination Program. In this program, you are assigned to one primary care provider, one pharmacy, one prescriber for controlled substances, and one hospital for non-emergency care. You must stay in the same plan for at least 12 months.
  • Inform the Health Care Authority if your family size or situation changes, such as pregnancy, births, adoptions, address changes, or if you become eligible for Medicare
  • Inform Molina Healthcare of any other insurance you have
  • Renew your coverage annually using the Washington Health Benefit Exchange at https://www.wahealthplanfinder.org, and report changes to your account such as income, marital status, births, adoptions, address changes, or if you become eligible for Medicare or other insurance

Behavioral Health Services Only (BHSO) Member Rights

  • Help make decisions about your behavioral health care, including the right to refuse treatment
  • Be informed about all treatment options available, regardless of cost
  • Change providers
  • Get a second opinion from another provider in your health plan
  • Get services without having to wait too long
  • Be treated with respect and dignity. Discrimination is not allowed. No one can be treated differently or unfairly because of his or her race, color, national origin, gender, sexual preference, age, religion, creed, or disability.
  • Speak freely about your health care and concerns without any bad results
  • Have your privacy protected and information about your care kept confidential
  • Ask for and get copies of your medical records
  • Ask for and have corrections made to your medical records when needed
  • Ask for and get information about:   
    • Your health care and covered services   
    • Your provider and how referrals are made to specialists and other providers   
    • How we pay your providers for your behavioral health care   
    • All of your options for care and why you are getting certain kinds of care   
    • How to get help with filing a grievance about your care, or help in asking for a review of a denial of services or an appeal   
    • Our organizational structure including policies and procedures, practice guidelines, and how to recommend changes
  • Receive plan policies, benefits, services, and Members’ Rights and Responsibilities at least yearly
  • Receive a list of crisis phone numbers
  • Receive help completing mental health or medical advance directive forms

Behavioral Health Services Only (BHSO) Member Responsibilities

  • Help make decisions about your behavioral health care, including refusing treatment
  • Keep appointments and be on time. Call your provider’s office if you are going to be late or if you have to cancel the appointment.
  • Give your providers information they need to be paid for providing services to you
  • Bring your Services Card and health plan ID card to all of your appointments
  • Learn about your health plan and what services are covered
  • Use health care services when you need them
  • Know your health problems and take part in your agreed-upon treatment goals as much as possible
  • Give your providers and Molina Healthcare complete information about your health
  • Follow your provider’s instructions for care that you have agreed to
  • Use health care services appropriately. If you do not, you may be enrolled in the Patient Review and Coordination Program. In this program, you are assigned to one primary care provider, one pharmacy, one prescriber for controlled substances, and one hospital for non-emergency care. You must stay in the same plan for at least 12 months.
  • Inform the Health Care Authority if your family size or situation changes, such as through pregnancy, births, adoptions, or address changes, or you become eligible for Medicare or other insurance
  • Renew your coverage annually using the Washington Health Benefit Exchange at https://www.wahealthplanfinder.org. and report changes to your account such as income changes, marital status changes, births, adoptions, address changes, or if you become eligible for Medicare or other insurance.