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Member Rights and Responsibilities

Magnolia members have the following rights:

  • To receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s ability to understand
  • To participate in decisions regarding his/her healthcare, including the right to refuse treatment
  • To seek second opinions
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in the federal regulations on the use of restraints and seclusion
  • To express a concern or appeal about Magnolia or the care it provides and receive a response in a reasonable period of time
  • To be able to request and receive a copy of his/her medical records (one copy free of charge) and request that they be amended or corrected by calling Member Services at 1-866-912-6285
  • To request and obtain information on any limits of your freedom of choice among network providers
  • To receive healthcare services that are accessible, are comparable in amount, duration and scope to those provided under Medicaid fee-for-service and are sufficient in amount, duration and scope to reasonably be expected to achieve the purpose for which the services are furnished
  • To receive services that are appropriate and are not denied or reduced solely because of diagnosis, type of illness, or medical condition
  • To a candid discussion of appropriate or medically necessary treatment options for their condition, regardless of cost or benefit coverage
  • To receive materials— including enrollment notices, informational materials, instructional materials, and available treatment options and alternatives—in a manner and format that may be easily understood
  • To receive oral interpretation services free of charge for all non-English languages, not just those identified as prevalent
  • To be notified that interpretation services are available and how to access those services
  • To receive information about the structure and operation of Magnolia
  • To receive information about physician incentive plans
  • Be free to exercise these rights without retaliation
  • To be treated with respect and with due consideration for your dignity and the right to privacy and non-discrimination as required by law
  • To privacy of healthcare needs and information as required by federal law (Standards for Privacy of Individually Identifiable Health Information)
  • Be furnished healthcare services in accordance with 42 C.F.R. 438.206 through 438.210
  • Receive information in a manner and format that may be easily understood in accordance with 42 C.F.R. 438.10
  • To voice complaints/grievances or file appeals about Magnolia’s decisions that affect the member’s privacy, medical care provided, services received and/or benefits
  • To receive information about Magnolia, its benefits, its services, its network providers, and member rights and responsibilities.
  • To receive information on the Grievance, Appeal and Medicaid’s State Fair Hearing procedures.
  • A right to make recommendations regarding the organization’s member rights and responsibilities.

 

Magnolia members have the following responsibilities:

  • To inform Magnolia of the loss or theft of a Magnolia member ID card
  • Present the Magnolia member ID card when using healthcare services
  • Be familiar with Magnolia procedures to the best of the member’s abilities
  • To call or contact Magnolia to obtain information and have questions clarified
  • To provide participating network providers with accurate and complete medical information
  • Following the prescribed treatment of care recommended by the provider or letting the provider know the reasons the treatment cannot be followed, as soon as possible
  • To understand their health problems and participate in developing mutually agreed upon treatment goals, to the degree possible
  • To make every effort to keep any agreed upon appointments, scheduled follow-up appointments and accessing and scheduling appointments for preventive healthcare services
  • To live healthy lifestyles and avoid behaviors known to be detrimental
  • To provide accurate and complete information to all healthcare providers
  • To become knowledgeable about Magnolia coverage provisions, rules and restrictions
  • To ask questions of providers to determine the potential risks, benefits, and costs of treatment alternatives, and then making care decisions after carefully weighing all pertinent factors
  • To follow the grievance and complaint  process established by Magnolia (and outlined in the member handbook) if there is a disagreement with a provider
  • To report truthful and accurate information when applying for Medicaid.  If inaccurate information is reported which results in enrollment being discontinued, the member will be responsible for repayment of capitation premium payments.