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Your Rights and Responsibilities

Your Members Rights are:

Confidentiality:
We will not let anyone else see information about the care you receive if you don’t want us to.  These are the times when we will share information about your services:

1. If it is required for the monitoring activities of Community Care, the Counties and/or the State.
2. If you or someone else could get hurt.  The law says that we must share information in order to get you or another person out of danger.

You have the right to ask for a copy of the following information:

1. The names, addresses, and phone numbers of providers who speak other languages
2. The names, addresses, and phone numbers of providers of service who are not accepting new patients
3. Any reasons why you could not choose a provider of service.  For example, Community Care will not provide referral information for treatment services that are not generally recognized by doctors
4. Your member rights and responsibilities
5. Information about grievances and fair hearing procedures
6. The benefits available to you, in detail
7. How to learn about additional benefits from the State of Pennsylvania
8. The steps that you (or a provider) need to take to receive services
9. The steps that must be taken to use a provider of service who is not in the network
10. The emergency benefits available to you, including:
11. What is an emergency
12. The steps for getting emergency service, including calling 911
13. The names, addresses, and phone numbers of emergency providers of service
14. That emergency services do not require approval
15. That any hospital can be used when there is an emergency
16. How emergency transportation is provided

You also have the right:

1. To receive information about Community Care, its services, its providers and the member rights and responsibilities.
2. To receive proper treatment regardless of your race, color, religion, lifestyle, disabilities national origin, age, gender, or income.
3. To be treated in a considerate and respectful manner with recognition of your dignity.
4. To receive services where your privacy is protected.
5. To an open discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage.
6. To choose any provider from the Community Care provider list.  You are free to change providers if you are unhappy.
7. To have your information kept private and confidential.
8. To know the name and the qualifications of any provider who is caring for you.
9. To voice complaints or grievances about Community Care or the care you receive and to see how Community Care responds to member complaints and grievances.  You have the right to a fair process that is easy to follow.
10. To make recommendations about Community Care’s member rights and responsibilities.
11. To receive a copy of the information that Community Care uses when we decide what care you should receive.
12. To know about the services you are receiving, why you are receiving them and what to expect.
13. To know everything you need to so you can make decisions about your care.
14. To work with providers or interpreters who understand you and your community.
15. To get information about Community Care that is clear and easy to understand.
16. To tell us if you are unhappy about any decision made by us or one of our providers.  You have the right to a fair process that is easy to follow.
17. To know about the qualifications of Community Care providers and staff.
18. To receive information about options to your treatment.  You have the right to receive this information in way that is easy to understand.
19. To play a part in the decisions about your care.  You also have the right to refuse treatment.
20. To not be restrained (tied down or locked in) or left alone – as a way for someone giving you treatment to bully you, punish you, or as a way for that person to take a break.
21. To ask for a copy of your medical record.  You have a right to correct information inside your record.
22. To know your rights and to not be treated differently because you do.
23. To a second opinion.
24. To ask and learn more about “Advance Directives”.

Members Responsibilities

It is important for you to:

1. Give Community Care and your provider the information needed to provide your care.
2. Tell your provider everything you know about your physical and mental health.  Also, tell this person what medicines you are taking, including over-the-counter (store bought) medicine(s). 
3. Tell your family doctor or PCP (primary care physician) about any counseling treatment.
4. Carry your ACCESS, Physical Health Plan (or Access Plus) and Community Care ID cards with you.
5. Go to a Community Care participating hospital in an emergency, if possible.    Call us within 24 hours if you have been seen for an emergency at a hospital that is not in our provider network.
6. Keep your appointments.  Call ahead to cancel if you must.
7. Understand your health problems and work together with your provider on an agreed-upon treatment plan.
8. Follow the treatment plan you have agreed upon with your provider.
9. Tell your provider if you want to stop or change treatment.
10. Tell Community Care and your provider about any other insurance you have.
11. Tell your provider and Community Care right away if your Medicaid status changes. 
12. Tell your provider and Community Care right away if you move.

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