Member Rights & Responsibilities
Your Rights as a MO HealthNet Managed Care Health Plan Member
You have the right to:
- Be treated with respect and dignity
- Receive needed medical services
- Privacy and confidentiality (including minors) subject to state and federal laws.
- Select your own PCP.
- Refuse treatment.
- Receive information about your health care and treatment options.
- Participate in decision-making about your health care.
- Have access to your medical records and to request changes, if necessary.
- Have someone act on your behalf if you are unable to do so.
- Get information on our Physician Incentive Plan, if any, by calling 1-855-694-HOME (4663).
- Be free of restraint or seclusion from a provider who wants to:
- Make you do something you should not do;
- Punish you;
- Get back at you; or
- Make things easier for him or her.
- Be free to exercise these rights without retaliation.
- Receive one copy of your medical records once a year at no cost to you
- Receive information about Home State, its services, its practitioners and providers and member rights and responsibilities.
- A candid discussion of appropriate or medically necessary treatment options for their conditions, regardless of cost or benefit coverage.
- To voice grievances or appeals about Home State or the care it provides.
- To make recommendations regarding the Home State’s member rights and responsibilities policy.
You have the responsibility to:
- Call Home State to order a member ID card if yours is lost
- Carry your Home State member ID card AND your MO HealthNet card at all times
- Contact your PCP first when needing medical care
- Only use the emergency room in an emergency
- Follow all instructions given by your health care provider
- Follow appointment scheduling rules
- Make and keep PCP appointments or call ahead to cancel
- Make sure your child sees his/her PCP for regular check-ups and shots
- Supply information (to the extent possible) that the organization and its providers need in order to provide care
- Follow plans and instructions for care that you have agreed to with your providers
- Provide all the information (to the extent possible) that the organization and its practitioners and providers need to care for you
- Show your Home State member ID card at all health care offices
- Understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible
- Provide information needed by providers in caring for the member
- Contact your PCP as their first point of contact when needing medical care
- Follow appointment scheduling processes
- Follow instructions and guidelines given by providers
How To Reach Utilization Review
Call your doctor if you think you need health care services. Some services may need review by Home State Health before they are given. The Home State Health Utilization Management Team does this review. You can call Member Services at 1-855-694-HOME (4663) (TDD/TTY: 1-877-250-6113) to see if something needs to be reviewed by Home State Health.
Emergency health care DOES NOT need to be approved before being given.
How Health Care Authorization Decisions Are Made
Home State Health reviews health care service requests to make sure they are medically necessary. This means getting the right care, at the right place, and at the right time. Home State Health uses standard guidelines to check medical necessity. Home State Health does not reward its staff or its network providers to deny care or encourage decisions that result in underutilization.
Approved: May 11, 2012