Member Rights & Responsibilities
As an MHS member, you have the right to…
- Receive information about MHS, as well as MHS services, practitioners, providers and your rights and responsibilities. We will send you a member handbook when you become eligible and a member newsletter four times a year. In addition, detailed information on MHS is located on our website at mhsindiana.com. Or you may also call Member Services at 1-877-647-4848.
- Be treated with respect and with due consideration for your dignity and privacy.
- Receive information on available treatment options and alternatives, presented in a manner appropriate to your condition and ability to understand.
- A candid discussion of appropriate or medically necessary treatment options, regardless of cost or benefit coverage.
- Participate with practitioners in decisions regarding your healthcare, including the right to refuse treatment.
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in federal regulations on the use of restraints and seclusion.
- Request and receive a copy of your medical records, and request that they be amended or corrected as allowed in federal healthcare privacy regulations.
- Voice complaints, grievances, or appeals about the organization or the care it provides.
- Make recommendations about our Member Rights and Responsibilities policy.
- An ongoing source of primary care appropriate to your needs and a person formally designated as primarily responsible for coordinating your healthcare services.
- Personalized help from MHS staff so you can ensure that you are getting the care needed, especially in cases where you or your child have “special healthcare needs” such as dealing with a long-term disease or severe medical condition. We make sure that you get easy access to all the care that is needed and will help coordinate the care with the multiple doctors and get case managers involved to make things easier for you. If you have been determined to have a special healthcare need by an assessment under 42 CFR 438.208(c)(2) that requires a course of treatment or regular care monitoring, we will work with you to provide direct access to a specialist as appropriate for your condition and needs.
- Have timely access to covered services.
- Have services available 24 hours a day, seven days a week when such availability is medically necessary.
- Get a second opinion from a qualified healthcare professional at no charge. If the second opinion is from an out-of-network provider, the cost will not be more than if the provider was in-network.
- Direct access to women’s health specialists for routine and preventative care, including family planning, annual women’s tests, and OB service without approval by MHS or your MHS doctor. This includes birth control, HPV tests, Chlamydia tests, and annual pap smears.
- Receive written notice of a decision to deny a service authorization request or to authorize a service in an amount, duration, or scope that is less than requested. You will receive this information as quickly as needed so that your medical needs are met and treatment is not delayed. We will not jeopardize your medical condition waiting for approval of services. Authorizations are reviewed based on your medical needs and made in compliance with State timeframes.
As an MHS member, you have the responsibility to…
- Provide information (to the extent possible) needed by MHS, its practitioners, and other healthcare providers so they can properly care for you.
- Follow plans and instructions for care in which you have agreed to with your MHS doctors.
- Understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
- To follow plans and instructions for care that you have agreed to with your practitioners.