YOUR RIGHTS AS A MEMBER

Each member has a right:

• To be treated with dignity and respect
• To be told by your doctor, nurse, or other provider of the options and alternatives of care offered, in a way that you can understand
• To be told about your health in a language that you can understand and, when needed, in foreign languages, mediums, and other formats [see how do I get language assistance?]
• To ask for and get spoken translation services free of charge
• To tell the Health Plan when you are not happy with a service or a decision
• To complain without any impact to the services that he or she gets from the health plan, doctors, nurses, or other providers

Not happy with a Health Plan service or decision? A member of a Health Plan has the right to tell the Health Plan when they are not happy with a service or a decision. If you have a complaint you can tell the Health Plan about it. If you are not happy with a decision, there are two chances to appeal it.

A complaint can also be known as a "grievance." A grievance is a formal way to tell a Health Plan about a problem with something like customer service. An appeal is a way to ask to change a decision made by a health plan. An example of an appeal is when a Health Plan does not approve a request for a service.

Want to know more about your right to complain or appeal? Look in your Health Plan member handbook under "Grievances and Appeals" or visit your health plan's webpage.

Not happy with the result of your Health Plan appeal? You can appeal to a unit within the Department whose main job is to hear appeals. Visit the Administrative Appeal Unit for more information on how to file an appeal.