Member Rights and Responsibilities

Your Member Rights

Peach State provides covered services to all members without regard to:

Age
Disability
Marital Status
Race
Sex
Income
Health Status
Arrest or Conviction
Religion
Sexual Preference
Color
Birth Nation
Military Participation
Language

All services that are covered and medically necessary may be obtained. All services are provided in the same way to all members.

Peach State providers who refer members for care do so the same way for all.

Translation services are available if you need them. This includes sign language. This service is free.

The right to appeal any denied service according to state guidelines.

You have the right:

To have all your personal information including your medical record kept private.
To be given choices about your healthcare. To know all of your options.
To never worry about someone forcing you to do something because it makes his or her job easier.
To ask for and receive a copy of your medical record.
To request your medical records.
You have the right to request that your medical records be changed or corrected.
The Quality Assessment Performance Improvement Program (QAPI) assures that all members receive quality care and appropriate care. The QAPI program focuses on improving clinical care and non-clinical care which will result in positive health outcomes.
To file a complaint against a doctor, hospital, the service/care you received, or Peach State. If you file a complaint, no one can stop you from continuing to get services.
To not pay if Peach State runs out of money to pay their bills.
To not pay for healthcare even if Medicaid or PeachCare for Kids and Peach State does not pay the doctor who treated you.
To never pay more than what Peach State would charge, if Peach State has to have someone else manage your care.
To only have a small co-payment and/or deductible, as allowed by state laws and DCH regulations.
To be treated with dignity, respect and privacy from Peach State staff, providers, physicians and their office staff.
To choose a Peach State doctor (PCP) and be told which hospitals to use.
To change your doctor without a reason.
To know about other doctors who can help you with treatment.
To know your rights and responsibilities with Peach State and to call if you have questions or comments or want to make changes to them.
To get information about Peach State’s organization and services, providers, physicians, and hospitals and your rights and responsibilities.
To get a second opinion.
To know about all the services you will get. This includes:
- Hours of operation.
- How to get emergency care after hours.
- How to get services if you are out of town.
- What may not be covered.
- What has limited coverage.
To be told if your services change. To be told if we cancel a service.
To be told if your doctor is no longer available.
To tell us and your doctor if you need help talking to your doctor. You will not have to pay if you are hearing impaired or if you do not speak English.
To know all information about your doctor(s) so they can care for you.
To tell your doctor what you like and don’t like about your care.
To speak with your physician about decisions related to your health care.
To help set treatment plans with your physician, talk to your physician openly and understand your health care options: regardless of cost or benefit coverage.
To understand your health problems and to speak with your physician about your treatment plans which you and your doctor agree.
To be free from any form of restraint or seclusion as a means of force, discipline, convenience or revenge.
To exercise these rights. Also, to know if you do, it will not change how you are treated by the plan, its doctors and providers.

Member Responsibilities

You have a responsibility:

To give information about yourself to the Peach State organization, providers, physicians, and hospitals in order to help set treatment goals.
To give info about you and your health to your PCP.
To understand your health problems and how to take your medicines the right way.
To ask questions about your health care.
To follow your instructions for care agreed upon by you and your physician or hospital.
To help set treatment goals with your PCP.
To read the Member Handbook to understand how [Peach State] works.
To call Peach State and ask questions when you don’t understand.
To always carry your Peach State Member ID card.
To always carry your Medicaid or PeachCare for Kids Member ID card.
To show your ID cards to each provider.
To schedule appointments for care with your doctor.
To go to the emergency room when you have an emergency.
To notify Peach State as soon as possible if you go to the emergency room.
To get a referral from your PCP for specialty care.
To cooperate with people providing your health care.
To be on time for appointments.
To notify the doctor’s office if you need to cancel an appointment.
To notify the doctor’s office if you need to change your appointment time.
To respect the rights of all providers.
To respect the property of all providers.
To respect the rights of other patients.
To not be disruptive in your doctor’s office.
To keep all your appointments. To be on time and cancel within twenty-four (24) hours if you cannot make it.
To treat your provider with dignity and respect.