Member Rights and Responsibilities
Your Child’s Member Rights
As a member of Medicaid and a member in a Plan, your child also has certain rights. You and your child 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 and who is responsible for your child’s 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 child’s diagnosis, the treatment you need, choices of treatments, risks and how these treatments will help you
- Say no to any treatment, except as otherwise provided by law
- Be given full information about other ways to help pay for your child’s 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, gender, sexual orientation, gender identify or source of payment
- Receive treatment for any health emergency that will get worse if your child does 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 child’s doctor (second medical opinion)
- Get a copy of your child’s medical record and ask to have information added or corrected in your child’s record, if needed
- Have your child’s medical records kept private and shared only when required by law or with your approval
- Decide how you want medical decisions made if you or your child can’t make them yourself (advance directive)
- To file a grievance about any matter other than a Plan’s decision about your child’s services
- To appeal a Plan’s decision about your child’s services
- Receive services from a provider that is not part of our Plan (out-of-network) if we cannot find a provider for your child that is part of our Plan
- Receive information about our Plan, its services, its practitioners and providers, and member rights and responsibilities
- Make recommendations regarding our Plan’s member rights and responsibility policy
- Get care without fear of restraint or seclusion used for bullying, discipline, convenience, or revenge
- Exercise these rights without changing the way Sunshine Health or its network providers treat you
Member Responsibilities
As a recipient of Medicaid and a member in a Plan, your child also has certain responsibilities. You have the responsibility to:
- Give accurate information about your child’s health to your Plan and providers
- Tell your provider about unexpected changes in your child’s health condition
- Talk to your child’s provider to make sure you understand a course of action and what is expected of you
- Listen to your child’s provider, follow instructions 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 your child has a change in information (address, phone number, etc.)
- Have a plan for emergencies and access this plan if necessary for your child’s safety
- Report fraud, abuse and overpayment
- Understand your child’s health problems and participate in developing mutually