RightCare members have both rights and responsibilities related to their membership and care
- You have the right to respect, dignity, privacy, confidentiality and nondiscrimination. That includes the
- Be treated fairly and with respect.
- Know that your medical records and discussions with your providers will be kept private and
- You have the right to a reasonable opportunity to choose a health care plan and primary care provider.
This is the doctor or health care provider you will see most of the time and who will coordinate your care.
You have the right to change to another plan or provider in a reasonably easy manner. That includes the
- Be told how to choose and change your health plan and your primary care provider.
- Choose any health plan you want that is available in your area and choose your primary care
provider from that plan.
- Change your primary care provider.
- Change your health plan without penalty.
- Be told how to change your health plan or your primary care provider.
- You have the right to ask questions and get answers about anything you do not understand. That
includes the right to:
- Have your provider explain your health care needs to you and talk to you about the different ways
your health care problems can be treated.
- Be told why care or services were denied and not given.
- You have the right to agree to or refuse treatment and actively participate in treatment decisions. That
includes the right to:
- Work as part of a team with your provider in deciding what health care is best for you.
- Say yes or no to the care recommended by your provider.
- You have the right to use each available complaint and appeal process through the managed care
organization and through Medicaid, and get a timely response to complaints, appeals and fair hearings.
That includes the right to:
- Make a complaint to your health plan or to the state Medicaid program about your health care,
your provider or your health plan.
- Get a timely answer to your complaint.
- Use the plan’s appeal process and be told how to use it.
- Ask for a fair hearing from the state Medicaid program and get information about how that process
- You have the right to timely access to care that does not have any communication or physical access
barriers. That includes the right to:
You have the right to not be restrained or secluded when it is for someone else’s convenience, or is
meant to force you to do something you do not want to do, or is to punish you.
You have a right to know that doctors, hospitals, and others who care for you can advise you about your
health status, medical care, and treatment. Your health plan cannot prevent them from giving you this
information, even if the care or treatment is not a covered service.
You have a right to know that you are not responsible for paying for covered services. Doctors, hospitals,
and others cannot require you to pay co-payments or any other amounts for covered services.
- Have telephone access to a medical professional 24 hours a day, 7 days a week to get any
emergency or urgent care you need.
- Get medical care in a timely manner.
- Be able to get in and out of a health care provider’s office. This includes barrier free access for
people with disabilities or other conditions that limit mobility, in accordance with the Americans
with Disabilities Act.
- Have interpreters, if needed, during appointments with your providers and when talking to your
health plan. Interpreters include people who can speak in your native language, help someone
with a disability, or help you understand the information.
- Be given information you can understand about your health plan rules, including the health care
services you can get and how to get them.
- You must learn and understand each right you have under the Medicaid program. That includes the
- Learn and understand your rights under the Medicaid program
- Ask questions if you do not understand your rights.
- Learn what choices of health plans are available in your area
- You must abide by the health plan’s and Medicaid’s policies and procedures. That includes the
- Learn and follow your health plan’s rules and Medicaid rules.
- Choose your health plan and a primary care provider quickly.
- Make any changes in your health plan and primary care provider in the ways established by Medicaid and by the health plan.
- Keep your scheduled appointments.
- Cancel appointments in advance when you cannot keep them.
- Always contact your primary care provider first for your non-emergency medical needs.
- Be sure you have approval from your primary care provider before going to a specialist.
- Understand when you should and should not go to the emergency room.
- You must share information about your health with your primary care provider and learn about service
and treatment options. That includes the responsibility to:
- Tell your primary care provider about your health.
- Talk to your providers about your health care needs and ask questions about the different ways
your health care problems can be treated.
- Help your providers get your medical records
- You must be involved in decisions relating to service and treatment options, make personal choices, and
take action to maintain your health. That includes the responsibility to:
- Work as a team with your provider in deciding what health care is best for you.
- Understand how the things you do can affect your health.
- Do the best you can to stay healthy.
- Treat providers and staff with respect.
- Talk to your provider about all of your medications.
If you think you have been treated unfairly or discriminated against, call the U.S. Department of Health and
Human Services (HHS) toll-free at 1-800-368-1019. You also can view information concerning the HHS Office
of Civil Rights online at www.hhs.gov/ocr
Information that must be available to you on a yearly basis
The following information must be made available to members on an annual basis (Balanced Budget Act
requirement). This should be stated as below:
Policy on referrals for specialty care and for other benefits you cannot get through your Primary Care
RightCare’s practice guidelines.
- As a member of RightCare from Scott and White Health Plan you can ask for and get the following information
- Information about network providers – at a minimum primary care doctors, specialist, and hospitals in
our service area. This information will include names, addresses, telephone numbers, and languages
spoken (other than English) for each network provider, plus identification of providers that are not
accepting new patients.
- Any limits on your freedom of choice among network providers.
- Your rights and responsibilities.
- Information on complaints, appeals and fair hearing procedures.
- Information about benefits available under the Medicaid program, including amount, duration and scope
of benefits. This is designed to make sure you understand the benefits to which you are entitled.
- How you get benefits including authorization requirements.
- How you get benefits, including family planning services, from out-of-network providers and/or limits to
- How you get after hours and emergency coverage and/or limits to those kinds of benefits, including:
- What makes up emergency medical conditions, emergency services and post-stabilization services.
- The fact that you do not need prior authorization from your Primary Care Provider for emergency
- How to get emergency services, including instructions on how to use the 911 telephone system or
its local equivalent.
- The addresses of any places where providers and hospitals furnish emergency services covered
- A statement saying you have a right to use any hospital or other setting for emergency care.
- Post-stabilization rules.
Notice of Privacy Practices
RightCare is required by Federal law to protect the privacy of Protected Health Information (PHI). We are
required to provide you with notice of our legal duties; privacy practices regarding the uses of PHI; and inform
you of your individual rights. The notice explains the purposes for which RightCare is permitted to use and
disclose your PHI. A full copy of the Notice of Privacy Practices can be found on our website at http://rightcare.swhp.org/en-us/privacy-policy. You can also request a paper copy by calling us at 1-855-897-4448.