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 your privacy.
- To select a primary care provider from HPN’s extensive provider list including the right to refuse care from specific practitioners.
- To be provided the opportunity to voice grievances or 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 your primary care provider in the decision making process regarding your health/dental care, including the right to refuse treatment.
- To have timely access to care and services, taking into account the urgency of your medical needs.
- 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.
- To have direct access to medically necessary specialist care, in conjunction with an approved treatment plan developed with the primary care provider. 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.
- 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 your medical records in accordance with applicable state and federal laws, including the ability to request and receive a copy of your medical records, and request that the medical records be amended or corrected, as specified in federal regulation.
- To have available oral interpretation services available 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.
Health Plan of Nevada Medicaid and Nevada Check Up Members have the RESPONSIBILITY:
- To know how HPN’s Managed Care Program operates.
- 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 maximize your health habits by understanding your health problems. To participate in developing and following up the health care plan and treatment goals that you, your physician and HPN have mutually agreed upon.
- To consult your primary care physician/dentist and HPN before seeking non-emergency care in the service area. We urge you to consult your physician/dentist and HPN when receiving urgently needed care while temporarily outside the HPN service area.
- To obtain a written referral from your physician/dentist before going to a specialist.
- To obtain prior authorization from HPN and your physician/dentist for any routine or elective surgery, hospitalization, or diagnostic procedures.
- To be on time for appointments and provide timely notification when canceling any appointment you 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 your medications. Keep a list and bring it with you to your appointment with your primary care provider And/or other providers, as applicable.
- To address medication refill needs at the time of your office appointment. When you obtain your last refill, notify the office that you will need refills at that time. Do not wait until you are out of your medication.
- To report all side effects of medications to your primary care provider. Notify your primary care provider if you stop taking your medications for any reason.
- To ask questions during your appointment time regarding physical complaints, medications, any side effects, etc.
