Member Rights and Responsibilities
As a member of Buckeye, you have the following rights:
- To receive all services that Buckeye must provide.
- To be treated with respect and with regard for your dignity and privacy.
- To be sure that your medical record information will be kept private.
- To be given information about your health. This information may also be available to someone who you have legally okayed to have the information or who you have said should be reached in an emergency when it is not in the best interest of your health to give it to you.
- To be able to take part in decisions about your healthcare unless it is not in your best interest.
- To get information on any medical care treatment, given in a way that you can follow.
- To be sure that others cannot hear or see you when you are getting medical care.
- To be free from any form of restraint or seclusion used as a means of force, discipline, ease, or revenge as specified in Federal regulations.
- To ask, and get, a copy of your medical records, and to be able to ask that the record be changed/corrected if needed.
- To be able to say yes or no to having any information about you given out unless Buckeye has to by law.
- To be able to say no to treatment or therapy. If you say no, the doctor or Buckeye must talk to you about what could happen and they must put a note in your medical record about it.
- To be able to file an appeal, a grievance (complaint) or state hearing. See pages 25-28 of this handbook for information.
- To be able to get all Buckeye written member information from Buckeye: o at no cost to you; o in the prevalent non-English languages of members in Buckeye’s service area; o in other ways, to help with the special needs of members who may have trouble reading the information for any reason.
- To be able to get help free of charge from Buckeye and its providers if you do not speak English or need help in understanding information.
- To be able to get help with sign language if you are hearing impaired.
- To be told if the healthcare provider is a student and to be able to refuse his/her care. To be told of any experimental care and to be able to refuse to be part of the care.
- To make advance directives (a living will). See the pamphlet in your new member packet which explains about advance directives. You can also contact member services for more information.
- To file any complaint about not following your advance directive with the Ohio Department of Health.
- To change your primary care provider (PCP) to another PCP on Buckeye’s panel at least monthly. Buckeye must send you something in writing that says who the new PCP is by the date of the change.
- To be free to carry out your rights and know that Buckeye, Buckeye’s providers or the Ohio Department of Medicaid will not hold this against you.
- To know that Buckeye must follow all federal and state laws, and other laws about privacy that apply.
- To choose the provider that gives you care whenever possible and appropriate.
- If you are a female, to be able to go to a woman’s health provider on Buckeye’s panel for covered woman’s health services.
- To be able to get a second opinion from a qualified provider on Buckeye’s panel. If a qualified provider is not able to see you, Buckeye must set up a visit with a provider not on our panel.
- To get information about Buckeye from us or the state.
- To know that Buckeye Representatives do not discriminate against any potential Member because of race, creed, age, color, sex, religion, culture, national origin, ancestry, marital status, sexual orientation, physical or mental disability, health status, or requirements for health care services. Services shall provide individuals equal access to its health programs or activities without discrimination on the basis of sex and treat individuals consistently with their gender identity.
- To contact the United States Department of Health and Human Services Office of Civil Rights and/or the Ohio Department of Job and Family Services’ Bureau of Civil Rights at the addresses below with any complaint of discrimination based on race, color, religion, sex, sexual orientation, age, disability, national origin, veteran's status, ancestry, health status or need for health services.
Office for Civil Rights
United States Department of Health and Human Services
200 Independence Avenue SW., Room 509F, HHH Building
Washington, DC 20201
1-800-368-1019; TTY: 1-800-537-7697
As a member of Buckeye, you also have several responsibilities. They are to learn and understand each right you have under the Medicaid program. That includes the responsibility to:
- Ask questions if you don't understand your rights.
- Make any changes in your health plan and primary care provider in the ways established by the Medicaid program and Buckeye.
- Keep your scheduled appointments.
- Have ID card with you.
- Notify PCP of emergency room treatment.
- Cancel appointments in advance when you can't keep them.
- If Buckeye is providing transportation for you to a medical appointment, you must provide a car seat for any child riding with you if the child is 4 years of age or younger, or if the child weighs less than 40 pounds.
- Always contact your PCP or Buckeye's NurseWise first for your non-emergency medical needs.
- Only go to the emergency room when you think it is an emergency.
- To share information relating to your health status with your PCP and become fully informed about service and treatment options. That includes the responsibility to:
- Tell your PCP about your health.
- Talk to your providers about your healthcare needs and ask questions about the different ways your healthcare problems can be treated.
- Help your providers get your medical records.
- Actively participate in decisions relating to safe service and treatment options, make personal choices, and take action to maintain your health. That includes the responsibility to:
- Work as a team with your provider in deciding what healthcare is best for you.
- Do the best you can to stay healthy.
- Treat providers and staff with respect.
- Buckeye provides services to our members because of a contract that Buckeye has with the Ohio Department of Medicaid. If you want to contact Ohio Department of Medicaid you can call or write to:
Ohio Department of Medicaid
Bureau of Managed Health Care
505 South High Street Suite 200
Columbus, Ohio 43215
1-800-605-3040 or 1-800-324-8680 TTY: 1-800-292-3572
You can also visit Ohio Department of Medicaid
on the web at www.medicaid.ohio.gov/
Center for Medicare & Medicaid Services
- You can contact Buckeye to get any other information you want, including the structure and operation of Buckeye, and how we pay our providers.
- If you want to tell us about things you think we should change, please call the Member Services department at 1-866-246-4358 ( TTY 1-800-750-0750)for Medicaid information and 1-866-389-7690 ( TTY 1-800-750-0750) for Medicare information.
- You have the right to make recommendations about Buckeye’s Member Rights and Responsibilities policies.
- You have the right to ask Buckeye about how we evaluate new healthcare procedures and services that we cover as a benefit.
- You have the right to ask Buckeye about our reasons for the decisions we make about your healthcare.
- At Buckeye, your privacy is important to us. We will do all we can to protect your health records. By law, we must protect your health records and send you a Privacy Notice, which we have included at the end of this Handbook. The Privacy Notice tells you how we use your health records. It describes when we can share your records with others. It explains your rights about the use of your health records. It also tells you how to use those rights and who can see your health records. The notice does not apply to information that does not identify you. When we talk about your health records in the notice, it includes any information about your past, present or future physical or mental health while you are a member of Buckeye. This includes providing healthcare to you. It also includes payment for your healthcare while you are our member. If you would like a copy of this Privacy Notice, please call Member Services at 1-866-246-4358: (Medicaid) or 1-866-389-7690 (Medicare) TTY 1-800-750-0750.