Rights and Responsibilities
As a member of EZ CARE, you have certain rights that are given to you:
Information:
ü To know the names of all doctors and other health care professionals in your medical treatment.
ü To be given information about your health plan, services, and use.
ü Get information about co-payments and fees that you must pay.
ü Get information about the doctors, hospitals and other providers that are in the plan.
ü Be told how to file a complaint or appeal with the plan.
ü Get information from doctors about your medicines, including what the medicines are, how to take them, and side effects.
ü To be informed by your doctor or other health care professional about any treatment you may receive and have your doctor request your consent for all treatment, unless there is an emergency and your life and health are in serious danger. If written consent is necessary for procedures, such as surgery, be sure you understand the risks and why the procedure or treatment is needed.
ü To know of continuing health care after leaving from the hospital.
ü Get an explanation of non-covered services.
ü Get a fast answer when you ask the plan questions or want information.
ü Get a copy of the plan’s Member Rights and Responsibilities Statement.
Upon Request the Following are Available to You:
ü Full explanation of the way Authorization and Referral work in the plan.
ü Full explanation of the way used to decide if medical services are “medically necessary”
ü An explanation of EZ CARE’s Quality Assurance and Performance Indicator program.
ü Policies and Procedures for EZ CARE’s drug benefits, including the disclosure, upon ü Policies and Procedures relating to the privacy and disclosure of member records.
ü Policies and procedures that talks about the needs of non-English speaking patient.
ü A full explanation of the process used for hiring our doctors under contract with or employed by EZ CARE and any doctor incentive plans.
ü Information on the operation and structure of the health plan.
The request may be done in writing or by phone to our Member Services Department.
Access to Care:
ü Get care from the doctor (PCP) you chose from the plan.
ü Change your doctor (PCP) to another doctor (PCP) who is working with the plan.
ü Get needed care from specialists, hospitals and other doctors in the plan.
ü Be told by your doctor how to make appointments and get treatment during and after office hours.
ü Be told how to get in touch with your doctor (PCP) or a back-up doctor 24 hours a day, every day.
ü Call 911 (or any available emergency service) or go to the nearest emergency/urgent care facility when you have an emergency medical condition.
ü Get urgently needed medically necessary care.
The Freedom to Make Decisions:
ü Apply these rights regarding to sex, age, and race, cultural, economic, educational or religious background.
ü Have any person who has legal rights to make medical care decisions for you exercise these rights on your behalf.
ü Refuse treatment providing you choose to accept responsibility and the cost of such a choice.
ü Complete an Advance Directive, Living Will or other instructions and give it to your health care doctors.
ü Know that you or your doctor cannot be punished for filing a complaint or appeal.
Personal Rights:
ü To be treated with respect and in a way that shows your need for privacy and self-respect.
ü Help your doctor make decisions about your health care.
As a member of EZ CARE you have a Responsibility To:
Exercise Your Rights:
ü Choose a doctor (PCP) from the plan and form a patient/doctor relationship.
ü Help your doctor make decisions about your health care.
Follow Instructions:
ü Read and understand your plan and benefits. Know the co-payments and what services are covered and what services are not covered.
ü Follow the orders and advice you and your doctor have agreed.
ü See the specialists your doctor (PCP) sends you to.
ü Make sure you have the right approval for the services, including hospitalization and out-of-network treatment.
ü Show your member ID card in the doctor’s office before seeing them.
ü Pay the co-payments required by your plan.
ü Quickly follow your plan’s complaint procedures if you believe you need to make a complaint.
ü Treat doctors, their staff, and the staff of the plan with respect.
ü Do not be involved in any false actions to the plan or any doctor.
Communicate:
ü Be responsible for knowing and following doctor’s information about your care and to ask questions if you do not understand or need details.
ü Tell your doctor quickly when you have sudden problems or symptoms.
ü Ask your doctor for referrals to non-emergency covered specialist or hospital care.
ü Understand that doctors in the plan and other health care professionals who care for you are not employees of EZ CARE and that EZ CARE does not control them.
ü Call Member Services about your plan if you do not understand how to use your benefits.
ü Give correct and complete information to doctors and other health care professionals who care for you.
ü Let EZ CARE know about other medical plan you or your family members may have.
You may have additional rights and responsibilities depending upon any State law related to your plan.
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