Member Rights & Responsibilities: Medicaid

Member Rights and Responsibilities: Medicaid/Healthy Michigan Plan Members

You have rights as a McLaren Health Plan (MHP) member. You also have responsibilities as an MHP member. MHP employees and providers are aware of these rights and duties and agree to follow them. If you do not understand your rights and duties, please call Customer Service at (888) 327-0671.

Your Rights

  • The right to confidentiality.
  • The right to be treated with respect and dignity and the right to privacy, including to be free from restraint and seclusion.
  • The right to have a primary care provider at all times.
  • The right to receive culturally and linguistically appropriate services.
  • The right to receive covered benefits consistent with your contract and State and Federal regulations.
  • The right to a current listing of network providers and access to a choice of specialists within the network who can treat chronic problems.
  • The right to get routine OB/GYN and pediatric services without a referral if the OB/GYN or pediatric specialist is a participating provider.
  • The right to receive Federally Qualified Health Clinic (FQHC) services.
  • The right to continue receiving medically necessary services from a provider who is no longer in the MHP network.
  • The right for female members who are pregnant to continue coverage with a provider who is no longer in the MHP network (that includes up to 6 weeks after you have your baby).
  • The right to have no “gag rules” from MHP (doctors are free to discuss all medical treatments, even if they are not covered services).
  • The right to participate in decision making regarding your health care.
  • The right to refuse treatment, to get a second opinion, and talk about treatment options.
  • The right to receive a copy of your medical record upon request and request those records to be amended or corrected.
  • The right to know how MHP pays its doctors.
  • The right to be provided with a telephone number and address to obtain additional information about payment methods, if desired.
  • The right to tell us if you have a complaint about MHP, the care provided, and the right to appeal a decision to deny or limit coverage.
  • The right to know that you or your doctor cannot be penalized for filing a complaint or appeal about your care.
  • The right to receive information about the structure and operation of MHP, including the services, providers of care and your rights and duties.
  • The right to make suggestions regarding MHP members’ rights and duties.
  • The right to have your medical record kept confidential by MHP and your provider.
  • The right to be free from other discrimination prohibited by state and federal regulations.

Your Responsibilities

  • You should schedule appointments in advance and be on time.
  • If you need to cancel an appointment with any doctor’s office, call as soon as possible.
  • You should use the hospital emergency room only for emergency care (if possible, you should call your doctor before going to the emergency room).
  • You need to give all the information that you can to your doctors and MHP so they can care for you in the best way
  • You need to ask questions if you do not understand the care you are getting.
  • You need to talk about your care and help your doctors plan what you will be receiving.
  • You need to complete the treatments that you have agreed to and follow all plans of care.
  • You should tell the Department of Human Services (DHS) and Customer Service right away of any change in address or telephone number.
  • You should help MHP assist you with your health care by telling us any problems you have with services.
  • You should tell us your suggestions in writing or by contacting Customer Service for assistance.
  • You must carry your MHP member ID card at all times.

(January 2016)