Member Rights and Responsibilities

Your Member Rights

As a recipient of Medicaid and a member in a Plan, you also have certain rights. You have the right to:

  • Be treated with courtesy and respect
  • Have your dignity and privacy respected at all times
  • Receive a quick and useful response to your questions and requests
  • Know who is providing medical services, who is responsible for your care and participate in making decisions about your health care
  • Know what member services are available, including whether an interpreter is available if you do not speak English
  • Know what rules and laws apply to your conduct
  • Be given information about your diagnosis, the treatment you need, choices of treatments, risks, and how these treatments will help you, regardless of cost or benefit coverage
  • Say no any treatment, except as otherwise provided by law
  • Be given full information about other ways to help pay for your health care
  • Know if the provider or facility accepts the Medicare assignment rate
  • To be told prior to getting a service how much it may cost you
  • Get a copy of a bill and have the charges explained to you
  • Get medical treatment or special help for people with disabilities, regardless of race, national origin, religion, handicap, or source of payment
  • Receive treatment for any health emergency that will get worse if you do not get treatment
  • Know if medical treatment is for experimental research and to say yes or no to participating in such research
  • Make a complaint when your rights are not respected
  • Ask for another doctor when you do not agree with your doctor (second medical opinion)
  • Get a copy of your medical record and ask to have information added or corrected in your record, if needed
  • Have your medical records kept private and shared only when required by law or with your approval
  • Decide how you want medical decisions made if you can’t make them yourself (advanced directive)
  • To file a grievance about any matter other than a Plan’s decision about your services
  • To appeal a Plan’s decision about your services
  • Receive services from a provider that is not part of our Plan (out-of-network) if we cannot find a provider for you that is part of our Plan
  • Receive information about the Vivida Health, its services, its practitioners and providers and member rights and responsibilities
  • Make recommendations about Vivida Health’s member rights and responsibilities policy
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation

 

Your Member Responsibilities

As a recipient of Medicaid and a member in a Plan, you also have certain responsibilities. You have the responsibility to:

  • Give accurate information about your health to Vivida Health plan and providers
  • Tell your provider about unexpected changes in your health condition
  • Talk to your provider to make sure you understand a course of action, what is expected of you and that you agree on what care is best for you
  • Listen to your provider, follow plans and instructions you and your provider agreed to and ask questions
  • Keep your appointments or notify your provider if you will not be able to keep an appointment
  • Be responsible for your actions if treatment is refused or if you do not follow the health care provider’s instructions
  • Make sure payment is made for non-covered services you receive
  • Follow health care facility conduct rules and regulations
  • Treat health care staff with respect
  • Tell us if you have problems with any health care staff
  • Use the emergency room only for real emergencies
  • Notify your case manager if you have a change in information (address, phone number, etc.)
  • Have a plan for emergencies and access this plan if necessary for your safety
  • Report fraud, abuse and overpayment

 

Patient Responsibility

You have to pay for the patient responsibility when you live in a facility, like an assisted living facility or adult family care home. Patient responsibility is the money you must pay towards the cost of your care. DCF will tell you the amount of your patient responsibility. Patient responsibility is based on your income and will change if your income changes.

 

Emergency Disaster Plan

Disasters can happen at any time. To protect yourself and your family, it is important to be prepared. There are three steps to preparing for a disaster: 1) Be informed; 2) Make a Plan and 3) Get a Kit. For help with your emergency disaster plan, call Member Services or your case manager. The Florida Division of Emergency Management can also help you with your plan. You can call them at 1-850-413-9969 or visit their website at https://www.floridadisaster.org/

 

Abuse/Neglect/Exploitation of People

You should never be treated badly. It is never okay for someone to hit you or make you feel afraid. You can talk to your PCP or case manager about your feelings.
If you feel that you are being mistreated or neglected, you can call the Abuse Hotline at 800-96-ABUSE (800-962-2873) or for TTY/TTY at 800-955-8771.
You can also call the hotline if you know of someone else that is being mistreated.
Domestic Violence is also abuse. Here are some safety tips:

  • If you are hurt, call your PCP
  • If you need emergency care, call 911 or go to the nearest hospital. For more information, see the section called EMERGENCY CARE
  • Have a plan to get to a safe place (a friend’s or relative’s home)
  • Pack a small bag, give it to a friend to keep for you

If you have questions or need help, please call the National Domestic Violence Hotline toll free at 800-799-7233 (TTY 800-787-3224).

 

Getting More Information

You have a right to ask for information. Call Member Services or talk to your case manager about what kinds of information you can receive for free. Some examples are:

  • Your member record
  • A description of how we operate
  • HEDIS results (As a new health plan, Vivida Health will not have HEDIS scores until after 2019.)