Member Rights and Responsibilities
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.
right to get services that are fitting and are not denied or reduced due
- Type of illness
- Medical condition
right to be given information in a manner and format they can understand
as defined in the Provider Agreement and the Member Handbook. This
- 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.
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.