Member Rights and Responsibilities
Know your rights.
As a member you have certain rights. Nebraska Total Care wants to always respect your rights. We expect our providers to respect your rights.
Your rights are
- To be treated with respect, dignity, and privacy. To have your rights acknowledged.
- To pick or change doctors from the provider network.
- To be able to get in touch with your provider.
- To go to any provider or clinic for family planning services.
- To get care right away if you have a medical emergency.
- To be told what your illness or medical condition is.
- To be told appropriate or medically necessary treatment options. To be told the alternatives that your provider thinks is best regardless of cost or benefit coverage.
- To get information on treatment option in a way that you can understand, regardless of cost or coverage.
- To make decisions about your health care with your provider.
- To give permission before the start of diagnosis, treatment or surgery.
- To refuse treatment without worrying that you will lose your coverage.
- To report any complaint or grievance about your provider, medical care, your plan, or Nebraska Total Care.
- To appeal action that reduces or denies services based on medical criteria.
- To receive interpretation services for free in any language.
- To not be pressured into making decisions about treatment.
- To not be discriminated against due to race, color, national origin or health status or the need for healthcare services.
- To request a second opinion.
- To request disenrollment and be notified at the time of enrollment and annually of your disenrollment rights.
- To make an Advance Directive.
- To file any complaint with Nebraska DHHS if your Advance Directive is not followed.
- To choose a provider who gives you care whenever possible and appropriate.
- To receive available and accessible healthcare services similar to services given under Medicaid FFS. This includes similar amount, duration and scope.
- To get enough services to be reasonable expected to achieve the goal of the treatment.
- To not have your services denied or reduced just because of a specific diagnosis, type of illness or medical condition.
- To use your rights without any negative effects from Nebraska DHHS, Nebraska Total Care, its providers or contractors.
- To receive all written member information from Nebraska Total Care:
- At no cost to you.
- In languages other than English.
- In other ways, to help with the special needs of members who may have trouble. reading the information for any reason.
- To be told that interpretation services are available and how to get them.
- To get help understanding the requirements and benefits of Nebraska Total Care from Nebraska DHHS and its Enrollment Broker.
- To be able to get information about Nebraska Total Care plan, service, doctors and providers, and member rights and responsibilities policies
- To be able to give your ideas for Nebraska Total Care rights and responsibilites policy
- If you are female, to be able to go to a woman’s health provider from the provider network for covered women’s health services.
- To not be discriminated against due to race, creed, age, color, sex, religion, culture, national origin, ancestry, marital status, sexual orientation, physical or mental disability, health status or the need for healthcare services.
- To have equal access to services, health programs, or activities without discrimination on the basis of gender identity and to be treat consistent with your gender identity.
- To be free from any form of restraint or seclusion used as a means of coercion, discipline, retaliation, convenience or to force you to do something you don’t want to do.
- To talk with your doctor about your medical records.
- To ask for and receive a copy of your medical records and/or a summary of your records free of charge.
- To request that your medical records be changed or corrected. To have your records kept private.
- To be told if the healthcare provider is a student and to be able to refuse his/her care.
- To be told of any experimental care and to refuse to be part of the care.
Know your responsibilities.
As a member you have certain responsibilities. Treatment can work better if you do these things.
Your responsibilities are
- Notify Heritage Health if:
- Your family size changes
- You move out of the state or have other address changes
- You get or have health coverage under another policy, other third party, or there are changes to that coverage
- Work on improving your own health.
- Tell Nebraska Total Care when you go to the emergency room.
- Talk to your provider about preauthorization of services they recommend.
- Be aware of cost-sharing responsibilities. Make payments that you are responsible for.
- Inform Nebraska Total Care if your member ID card is lost or stolen.
- Show your member ID card and Nebraska Medicaid ID card when getting healthcare services.
- Know Nebraska Total Care procedures, coverage rules, and restrictions the best that you can.
- Contact Nebraska Total Care when you need information or have questions.
- Give providers accurate and complete medical information.
- Follow prescribed treatment. Or tell your provider the reason(s) treatment cannot be followed as soon as possible.
- Ask your providers questions to help you understand treatment. Learn about the possible risks, benefits, and costs of treatment alternatives. Make care decisions after you have thought about all of these things.
- Be actively involved in your treatment. Understand your health problems and be a part of making treatment goals with your provider as much as you can.
- Follow the grievance process if you have concerns about your care.
- Notify Nebraska Total Care, your provider, and Heritage health of changes to your address and phone number.
- Treat providers and staff with respect.
- Cancel appointments in advance when you can’t keep them whenever possible.