Rights and Responsibilities

RIGHTS AND RESPONSIBILITIES

RIGHTS AND RESPONSIBILITIES


MeridianComplete wants you to know that you have certain rights and responsibilities. You should always be treated with respect and dignity by us and by your doctor. MeridianComplete staff and its network health care providers strive to comply with all requirements concerning your rights.

You have a right to:

  • Receive healthcare services consistent with MeridianComplete's contract with the state and all state and federal regulations
  • Receive basic information about MeridianComplete, MeridianComplete services, your person-centered plan of care (if applicable), MeridianComplete practitioners and providers and enrollee rights and responsibilities
  • Have basic MeridianComplete information be accessible in alternative formats that meet your communication needs
  • Request information on the structure and operation of MeridianComplete
  • Have your questions about MeridianComplete answered
  • Be treated with respect and recognition of your dignity and right to privacy
  • Confidentiality of your personal and medical information
  • Request and receive a copy of your medical records and request that they be amended or corrected
  • Participate with practitioners in making decisions about your health care, including the right to refuse treatment and express preferences about treatment options
  • Receive a clear explanation from your provider and Meridian of your condition(s) and your plan of care, proposed treatment options and alternatives, benefits and drawbacks for potential treatment plans and the possible consequences for noncompliance with a recommended care plan regardless of MeridianComplete coverage or provider panel
  • A candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage
  • Voice complaints or appeals about MeridianComplete or the care it provides
  • Make recommendations regarding MeridianComplete's policies and procedures
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation
  • Be free to exercise all of these rights without adversely affecting the way MeridianComplete, providers or the state treats you
  • Get information on our provider incentive programs. MeridianComplete may give incentives to providers to help make sure you get the care you need when you need it. We will give you this information upon your request
  • Be free from receiving bills, cost-sharing or co-payments for MeridianComplete covered medical services, including those provided to an American Indian/Alaskan Native by an American Indian provider or medical provider
  • Be free from other discrimination prohibited by state and federal regulation, including race, color, religion, sex, national origin, ancestry, age, physical or mental disability, claims experience, receipt of health care, medical history, genetic information and evidence of insurability, including but not limited to, the Federal Civil Rights Act of 1964, the Americans with Disabilities Act of 1990, the Federal Rehabilitation Act of 1973, Title IX of the Education Amendments of 1972, the Age Discrimination Act of 1975, the State's Human Rights Act, and Executive Orders 11246 and 11375. Members have the right to appeal to or file directly with the United States Department of Health and Human Services Office of Civil Rights any complaints of discrimination
  • Have access to doctors, other healthcare providers, specialists and hospitals including American Indian providers in and out of the state
  • To get emergency care when and where you need it
  • To get a decision about healthcare payment, services or prescription drug coverage
  • To request a fair hearing and to file grievances and appeals as described in the new member material
  • Right to reasonable accommodation


You have the responsibility to: 

  • Learn about your rights and responsibilities as a MeridianComplete member
  • Give MeridianComplete and your providers as much information about your health as possible
  • Learn about your health problems
  • Work with MeridianComplete and your provider to set and achieve healthcare plans and goals
  • Follow the care plans and orders that you agreed on with your providers
  • Live a healthy lifestyle and make responsible healthcare decisions
  • Tell MeridianComplete if your contact information (like your address or phone number) changes

To receive more information about your rights and responsibilities: 

 

1. Call our Member Services Department at

1-855-580-1689 (TTY 711), Monday - Sunday from 8 a.m. – 8 p.m.

2. Visit http://www.medicare.gov to review and download "Your Medicare Rights & Protections."

 

3. Call 800-MEDICARE (800-633-4227). TTY users should call 877-486-2048, 24 hours a day, 7 days a week.

To learn more about your rights and responsibilities upon disenrollment click here.

MEDICARE DISCLAIMER

MeridianComplete is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees.

 

You can get this document in Spanish, or speak with someone about this information in other languages for free. Call

1-855-580-1689 (TTY users should call 711)

,

Monday - Sunday, 8 a.m. to 8 p.m.

  The call is free.

 

Usted puede obtener gratuitamente este documento en español o hablar con alguien sobre esta información en otros idiomas. Llame al

1-855-580-1689

(los usuarios de TTY deben llamar al 711), lunes a domingo, de 8 a.m. a 8 p.m. La llamada es gratuita.

 

Limitations, copays, and restrictions may apply. For more information, call MeridianComplete Member Services or read the MeridianComplete Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year

The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

 

Copays for prescription drugs may vary based on the level of Extra Help you receive. Please contact the plan for more details.

 

For certain kinds of drugs, you can use the plan’s network mail-order services. We also have an optional automatic mail-order delivery program under which we will automatically fill all new prescriptions your health care provider sends to us, as well as refills for prescriptions that have already been filled but are running out. Usually a mail-order pharmacy order will get to you in no more than 5 days. If you experience any problems receiving your mail order prescription, call Member Services at

1-855-580-1689 (TTY users should call 711)

.

Page Last Modified: 11/20/2017 2:43:27 PM