Member Rights & 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 call Member Services.

Your Rights as a Member

Information you can get:

• The name of your PCP and/or case manager.
  
• 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 copy of the MCP Acute Member Handbook.
  
• A description of covered services.
  
• 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 costs and uses services.
  
• The right to know whether stop-loss insurance is required.
  
• 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, and 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 other formats. Call Member Services for assistance.

Treatment Decisions

• You can choose a Mercy Care Plan PCP to coordinate your health care.
  
• You can change your PCP.
  
• You can find out if physicians are on a incentive plan that may affect the use of referral services
  
• 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 get a second opinion arranged outside of the network at no cost to you.
  
• 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 ask MCP to amend or correct your medical records.
  
• You will be told in writing by Mercy Care Plan when any of your health care services requested by your PCP are reduced, suspended, terminated or denied. You must follow the instructions in your notification letter.
  
• 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.

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. 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 can refuse care from a doctor you were referred to and ask for a different doctor.
  
• You may request a second opinion from another Mercy Care Plan doctor.
  

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 Mercy Care 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.

Your Responsibilities as a Member

Respect

• Respect the doctors, pharmacists, staff and people providing services to you.
  
• Protect your member ID card. Do not lose it or share it with anyone.
  

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. Mercy Care Plan Member Handbook 2011 - 2012
  
• Tell your PCP and/or your case manager about any other insurance you may have and apply for other benefits you may be eligible for.
  
• Give your PCP all the facts about your health problems, past illnesses, hospital stays, all medications, shots and other health concerns. Let your PCP and/or your case manager know about any changes in your condition.
  
• Notify Mercy Care any time you feel a provider or another member is not using health plan benefits correctly.
  
• Report changes like your address, telephone number and/or assets, and other matters that could affect your eligibility to your case manager and/or the interviewer at the office where you applied for AHCCCS.
  

Follow Instructions

• Know the name of your assigned PCP and/or 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 don’t follow these instructions.
  
• Bring your child’s shot record to all your child’s PCP visits.
  

Appointments

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

MEMBER IDENTIFICATION CARD

AHCCCS will send you a member identification (ID) card when you join Mercy Care Plan. Your ID card will have your name, ID number and the name of your health plan. If you do not get your card, call AHCCCS at 602-417- 7000 or 1-800-962-6690. If you lose your card, call AHCCCS for a new one.

If you are a DD member, Mercy Care Plan will send your member ID card with your welcome packet. If you lose your card, call Member Services for a new one.

Protect your ID card! Do not give it to anyone except those giving you health care services. If you loan, sell or give your ID card to anyone else, you may lose your AHCCCS benefits and/or legal action may be taken.

If you lose eligibility, do not throw away your member ID card. You will not be given another card if you become eligible again.