Medicaid and Nevada Check Up Members' Rights and Responsibilities
Health Plan of Nevada (HPN) is committed to maintaining a strong relationship with its members and treating members in a manner that respects their rights and promotes effective health care. To this end, HPN has established Member’s’ Rights and Responsibilities as listed below.
If you have any questions or concerns about your Rights or Responsibilities, please contact Member Services at 702-242-7317, TTY 711 or toll-free at 1-800-962-8074. If you require translation services, Member Services can also assist you.
Health Plan of Nevada Medicaid and Nevada Check Up Members have the RIGHT:
- To be treated with respect and dignity and every effort made to protect their privacy.
- The freedom to select a primary care physician including specialists as their PCP if the recipient has a chronic condition from HPN’s extensive provider list including the right to refuse care from specific practitioners. Members may contact Customer Service for assistance in making a selection or changes.
- To be provided the opportunity to voice grievances appeals about the plan and/or the care provided and to pursue resolution of the grievance or appeal.
- To receive information about the plan, its services, its providers, and members’ rights and responsibilities in a manner and format that is easily understood and in languages (other than English) that are commonly used in the service area.
- To participate with their primary care physician in the decision-making process regarding health care, including the right to refuse treatment.
- To have timely access to care and services, taking into account the urgency of their medical needs. The member has the right to direct contact with qualified clinical staff. Urgent coverage means those problems which, though not life-threatening, could result in serious injury or disability unless medical attention is received.
- To have a candid discussion of available treatment options and alternatives for your conditions, regardless of cost or benefit coverage.
- To have direct access to women’s health services for routine and preventive care. Female members have access to the necessary providers for women’s routine and preventive health care services. This is in addition to the member’s designated PCP, if that source is not a women’s health specialist. Customer Service can assist with this selection.
- To have direct access to medically necessary specialist care, in conjunction with an approved treatment plan developed with the primary care physician/dentist. Required authorizations should be for an adequate number of direct access visits.
- To have access to emergency health care services in cases where a “prudent layperson” acting reasonably would have believed that an emergency existed. Emergency care is available twenty-four (24) hours per day, seven (7) days per week. The member has access to emergency services after business hours and on weekends. Members and providers have the right to direct contact with qualified clinical staff. Unrestricted access to emergency services whether in or out-of-network.
- To have adequate and timely services outside the network, if HPN’s network is unable to provide necessary services covered under your contract.
- To have a second opinion, at no cost, from a qualified health care professional within the network or arrangements made for you to obtain one outside the network.
- To formulate Advance Directives.
- To have access to medical records in accordance with applicable state and federal laws, including the ability to request and receive a copy of medical records, and request that the medical records be amended or corrected, as specified in federal regulation.
- To have available oral interpretation services free of charge for all non-English languages.
- To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation, as specified in federal regulation on the use of restraints and seclusion.
- To make recommendations regarding the organization’s members’ rights and responsibilities policies.
- To continuation of on-going care corresponding to a plan of care at the time of enrollment.
Health Plan of Nevada Medicaid and Nevada Check Up Members have the RESPONSIBILITY:
- To know how HPN’s Managed Care Program operates.
- To cooperate with those providing health care services, including providers and health plan staff.
- To provide, to the extent possible, information that HPN and its providers need in order to provide the best care possible.
- To follow instructions and guidelines given by those providing healthcare services.
- To take responsibility for maximizing health habits and to follow the health care plan that the member, physician and HPN have agreed upon.
- To consult with a primary care physician and HPN before seeking non-emergency care in the service area. We encourage members to consult their physician and HPN when receiving urgently needed care while temporarily outside the HPN service area.
- To obtain a written referral from a physician before going to a specialist.
- To obtain prior authorization from HPN and a physician for any routine or elective surgery, hospitalization, or diagnostic procedures.
- To be on time for appointments and provide timely notification when canceling any appointment a member cannot keep.
- To avoid knowingly spreading disease.
- To recognize the risks and limitations of medical care and the health care professional.
- To be aware of the health care provider’s obligation to be reasonably efficient and equitable in providing care to other patients in the community.
- To show respect for other patients, health care providers and plan representatives.
- To abide by administrative requirements of HPN, health care providers, and government health benefit programs.
- To report wrongdoing and fraud to appropriate resources or legal authorities.
- To know their medications.
- To address medication refill needs at the time of an office appointment. To report all side effects of medications to their primary care provider and to notify their primary care provider/dentist if they stop taking their medications.
- To ask questions during an appointment regarding physical complaints, medications, any side effects, etc.
- To participate in understanding their health problems and developing mutually agreed upon treatment goals.
- To report any on-going care corresponding to a plan of care at the time of enrollment.
- To report any third-parties responsible for payment of services.
