Your Rights and Responsibilities

As a Mercy Care Plan member, you have rights and responsibilities. These are listed below. It is important that you read and understand each one. If you have questions, please ask your case manager.

Your Rights as a Member

You, your family or your guardian(s) have the right to:

Information you can get

• The name of your PCP and case manager.
• Inspect your medical records.
• One copy of your medical records at no cost to you. You may not be able to get a copy of medical records that are psychotherapy notes put together for a civil, criminal or administrative action.
• A description of covered services.
• Get emergency services outside of Mercy Care Plan’s service area.
• Information about Mercy Care Plan, its services, providers and your rights and responsibilities as a member.
• How Mercy Care Plan provides for after hours and emergency care.
• How Mercy Care Plan pays providers, controls cost and uses services.
• General grievance results and a summary of member survey results.
• The cost to you if you choose to pay for a service that Mercy Care Plan does not cover.
• What treatment choices or other types of care are available to you and the benefits and/or drawbacks of each choice.
• How to get services, including authorization requirements.
• How MCP evaluates new technology to include as a covered service.
• Advance directives and information on how to have medical decisions made for you if you are not able to make them for yourself.
• Changes to your services or what to do if your PCP leaves Mercy Care Plan.

Respect and Dignity

• You can get covered services without concern about payer source, race, ethnicity, national origin (to include those with limited English proficiency), religion, gender, age, mental or physical disability, sexual orientation, genetic information, ability to pay or ability to speak English.
• You can get quality medical services that support your personal beliefs, medical condition and background in a language you understand.
• You can get interpretation services if you do not speak English or have a hearing impairment to help you get the medical services you need. You may ask for materials in an alternative format.

Treatment Decisions

• You can choose a Mercy Care Plan PCP to plan your health care.
• You can change your PCP if you need to.
• You can talk with your PCP to get complete and current information about your health care and condition so that you and/or your family understand and can be a part of making decisions about your health care.
• You can be informed about which procedures you will have and who will do them.
• You can decide who you want to be with you for treatments and exams.
• You can have a female in the room for breast and pelvic exams.
• You can say no to treatment, services or PCPs and be told what may happen if you do not have the treatment. Your eligibility or medical care does not depend on your agreement to follow a treatment plan.
• You can transfer or leave a long-term care home because of medical reasons, for your own good or the good of others, or for not paying.
• You will be told in writing by Mercy Care Plan when any of your health care services are reduced, suspended, terminated or denied. You must follow the instructions in your notification letter.

Emergency Care and Specialty Services

• You can get emergency health care services without the approval of your PCP or Mercy Care Plan when you have a medical emergency, and you may go to any emergency room or other setting for emergency care.
• You may get behavioral health services without the approval of your PCP or Mercy Care Plan
• You can see a specialist with a referral from your PCP.
• You may request a second opinion from a doctor outside of Mercy Care Plan’s network at no cost to you.
• You can refuse care from a doctor you were referred to and ask for a second opinion.

Confidentiality And Privacy

• You have a right to privacy and confidentiality of your health care information.
• You have a right to talk to health care professionals privately.

Reporting Your Concerns to the Health Plan

• Tell us about any complaints or issues you have with your health care services.
• You may file an appeal and get a decision in a reasonable amount of time.
• You can give Mercy Care Plan suggestions on changes to policies and services.

Personal Rights

• You may share a room with your husband or wife if you want to and it is appropriate, if you live in a nursing facility or an alternative residential facility.
• You may remain in your home if you want to.
• You have a choice of a single occupancy unit if you live in an Assisted Living Center.
• You can manage your own money or choose someone you trust to do it for you.
• You can use your rights as a citizen.
• You can choose to speak or not to speak with people.
• You can keep and use your personal clothing and belongings if there is space and if there are no medical reasons not to, if you live in a nursing facility or an alternative residential facility.
• You can say no to drugs or restraints, except for times when your doctor thinks it is needed to protect you or others from harm.
• You have the right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
• You have freedom to say no to tasks a provider may ask you to do that are not part of your care plan.

Your Responsibilities as a Member

As a member, you, your family or your guardian(s) have these responsibilities:

Respect

• Respect the doctors, pharmacists, staff and people providing services to you.
• Protect your ID card. Do not lose it or share it with anyone.
• Take care of equipment loaned to you, like wheelchairs and the things that belong to the place where you live.
• Be considerate of the rights of the staff and other people living in the same place.
• Be respectful of their property.

Share Information

• Show your member ID card or identify yourself as a Mercy Care Plan member to health care providers before getting services. If you have other insurance in addition to Mercy Care Plan, show your doctor or pharmacist your other insurance ID card as well.
• If you do not understand your health condition or treatment plan, ask your PCP to explain.
• Tell your doctor and/or case manager about any other insurance you may have, and apply for other benefits you may be eligible for.
• Give your doctor all the facts about your health problems, past illnesses, hospital stays, all medications, shots and other health concerns. Let your doctor and/or your case manager know about any changes in your condition.
• Notify Mercy Care Plan any time you feel a provider or another member is not using health plan benefits correctly.
• Report changes like your address, phone number and/or assets, and other matters that could affect your eligibility to your case manager and/or to the eligibility interviewer at the office where you applied for AHCCCS.

Follow Instructions

• Know the name of your assigned PCP and your case manager.
• Follow the instructions that you and your PCP have agreed on, including the instructions of nurses and other health care professionals. Ask what can happen if you do not follow these instructions.
• Pay your share of cost and/or room and board at the start of every month.

Appointments

• Schedule appointments during office hours when possible instead of using urgent or emergency care.
• Keep appointments, and come on time. Call your doctor’s office ahead of time when you cannot keep your appointment.