Your Rights and Responsibilities
Community Care will not disclose information about your care without permission, except when:
- It is required for the monitoring activities of Community Care, the Counties, and/or the State.
- Required by law.
You have the right to ask for a copy of the following information:
- The names, addresses, and phone numbers of providers who speak other languages.
- The names, addresses, and phone numbers of providers of service who are not accepting new patients.
- Any reasons why you could not choose a provider of service. For example, Community Care will not provide referral information for treatment services that are not generally recognized by doctors.
- Your rights and responsibilities.
- Information about grievances and fair hearing procedures.
- The benefits available to you, in detail.
- How to learn about additional benefits from the State of Pennsylvania.
- The steps that you need to take to receive services.
- The steps that must be taken to use a provider of service who is not in the network.
- The emergency benefits available to you, including:
- What is an emergency.
- The steps for getting emergency service, including calling 911.
- The names, addresses, and phone numbers of emergency providers of service.
- That emergency services do not require approval.
- That any hospital can be used when there is an emergency.
- How emergency transportation is provided.
You also have the right to:
- Receive information about Community Care, its services, its providers, and your rights and responsibilities.
- Receive proper treatment regardless of race, color, religion, lifestyle, disabilities national origin, age, gender, or income.
- Be treated in a considerate and respectful manner with recognition of your dignity.
- Receive services where privacy is protected.
- An open discussion of appropriate or medically necessary treatment options for conditions, regardless of cost or benefit coverage.
- Choose any provider from the Community Care provider list. You are free to change providers if you are unhappy.
- Have information kept private and confidential.
- Know the name and the qualifications of any provider.
- Voice complaints or grievances about Community Care or the care received and to see how Community Care responds to complaints and grievances. You have the right to a fair process that is easy to follow.
- Make recommendations about Community Care’s member rights and responsibilities.
- Receive a copy of the information that Community Care uses when we decide what care you should receive.
- Know about the services you are receiving, why you are receiving them, and what to expect.
- Know everything needed to make decisions about your care.
- Work with providers or interpreters who understand you and your community.
- Get information about Community Care that is clear and easy to understand.
- Tell us if you are unhappy about any decision made by us or one of our providers. You have the right to a fair process that is easy to follow.
- Know about the qualifications of Community Care providers and staff.
- Receive information about options for treatment. You have the right to receive this information in way that is easy to understand.
- Play a part in the decisions about your care. You also have the right to refuse treatment.
- Not be restrained (tied down or locked in) or left alone – as a way for someone giving treatment to bully, punish, or as a way for that person to take a break.
- Ask for a copy of your medical record. You have a right to correct information inside your record.
- Know members’ rights and to not be treated differently because you do.
- A second opinion.
- Ask and learn more about “Advance Directives.”
It is important for you to:
- Give Community Care and your provider the information needed to provide care.
- Tell your provider everything you know about your physical and mental health. Also, tell this person what medicines are being taken, including over-the-counter (store bought) medicine(s).
- Tell your family doctor or PCP (primary care physician) about any counseling treatment.
- Carry your ACCESS, Physical Health Plan, and Community Care ID cards with you.
- Go to a Community Care participating hospital in an emergency, if possible. Call us within 24 hours if you have been seen for an emergency at a hospital that is not in our provider network.
- Keep appointments. Call ahead to cancel if you must.
- Understand your health problems and work together with your provider on an agreed-upon treatment plan.
- Follow the treatment plan you have agreed upon with your provider.
- Tell your provider if you want to stop or change treatment.
- Tell Community Care and your provider about any other insurance you have.
- Tell your provider and Community Care right away if your Medicaid status changes.
- Tell your provider and Community Care right away if you move.