Member Rights and Responsibilities

Member Rights

As a member you have certain rights. Iowa Total Care wants to respect your rights and we expect our providers to respect your rights. Members have:

  • A right to receive information about Iowa Total Care, its services, providers and member rights and responsibilities.
  • A right to give their ideas for “Iowa Total Care’s member rights and responsibilities policy.”
  • A right to be treated with respect, dignity and privacy.
  • A right to get information on care options in a way that they can understand, regardless of cost or coverage.
  • A right to participate in decisions about their health care. This includes the right to refuse treatment.
  • A right to seek second opinions.
  • A right to get help with care coordination from the PCP’s office.
  • A right to express a concern or appeal about Iowa Total Care or the care it provides. To receive a response in a reasonable period of time.
  • A right to receive a copy of their medical records upon request. (One copy is free of charge.) To ask that they be amended or corrected.
  • A right to choose their health professional and long- term supports and services providers to the extent possible and appropriate, as per 42 CFR §438.6(m).
  • A right to be given health care services as per 42 CFR §§ 438.206 through 438.210.
  • A right to get health care services that are similar in amount and scope to those given under Medicaid Fee-For-Service. This includes the right to get health care services that will achieve the purpose for which the services are given.
  • A right to get services that are fitting and are not denied or reduced due to:
    • Diagnosis
    • Type of illness
    • Medical condition
  • A right to be given information in a manner and format they can understand as defined in the Provider Agreement and the Member Handbook. This includes:
    • Enrollment notices
    • Informational materials
    • Instructional materials
  • A right to treatment options and alternatives
  • A right to get free oral interpretation services for all non- English languages.
  • A right to be notified that interpretation services are available and how to access them.
  • A right to get adequate and timely information on Iowa Total Care’s Physician Incentive Plan upon request.

Member Responsibilities

As a member you have certain responsibilities. Treatment can work better if you do these things. Your responsibilities are:

Notify Iowa Medicaid 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
  • To inform Iowa Total Care of the loss or theft of an ID card.
  • To inform Iowa Total Care, their provider and the State Medicaid program of any change of address or phone number.
  • To present the Iowa Total Care ID card when using health care services.
  • To be familiar with Iowa Total Care procedures to the best of your abilities.
  • To contact Iowa Total Care to get information and have questions answered.
  • To give providers accurate and complete medical information.
  • To follow care prescribed by the provider or to let the provider know why treatment cannot be followed, as soon as possible.
  • To keep appointments and follow-up appointments. To access preventive care services.
  • To live healthy lifestyles and avoid behaviors known to be harmful.
  • To understand their health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
  • To give accurate and complete information needed for care to Iowa Total Care and all their health care and support providers.
  • To make their Primary Care Provider (PCP) aware of all other providers who are treating them. This is to ensure communication and coordination in care. This also includes behavioral health providers.
  • To learn about Iowa Total Care coverage provisions, rules and restrictions.
  • To ask questions of providers to learn the risks, benefits, and costs of treatment options. To make care decisions after carefully weighing all factors.
  • To follow Iowa Total Care’s grievance process outlined in the Member Handbook if there is a disagreement with a provider.
  • To choose a PCP.
  • To treat providers and staff with dignity and respect.