Member Rights and Responsibilities
Customer rights and responsibilities – Medicare
Medicare customers have the right:
- To be treated with respect and understand their need for privacy and dignity.
- To get help in a prompt, courteous, responsible and culturally competent manner.
- To be given information about their health care benefits.
- To be given information about any limitations and services not covered by the plan.
- To be told by their Provider all of their medical information in words they understand.
- To talk with their Provider about their care.
- To expect the health plan not to interfere with any contracted Providers talking with them about their treatment choices.
- To have the health plan send them to another contracted Provider if he/she does not agree to a treatment because of moral or religious grounds.
- To be given information about the list of contracted Providers in their service area.
- To be told by their Provider about any treatment they may get.
- To have their Provider ask for their permission for all treatment, unless there is an emergency and they cannot sign a consent form and their health is in serious danger.
- To refuse treatment, including any trial treatment, and be told of the possible outcome of their choice.
- To choose an advance directive to pick the kind of care they wish to get if they become unable to express their wishes.
- To select, without interference, a primary care Provider of their choice from the health plan's list of contracted Providers.
- To make suggestions about the member rights and responsibilities policy.
- To file a complaint about the health plan.
- To file a complaint about the care they have received and to get a timely response.
- To file a grievance if they are not satisfied with their health plan's decision about their complaint.
- To get "timely access" to the records and information that pertains to them.
Medicare customers have the responsibility:
- To know and confirm your benefits before getting treatment.
- To show your member ID card before getting services.
- To protect your member ID card from being used by another person.
- To verify that the Provider you get services from is part of the health plan network.
- To keep scheduled appointments.
- To pay any copayments/coinsurance at the time you get treatment.
- To ask questions and understand the care you are getting.
- To follow the advice of your Provider and be aware of the possible outcomes if you do not.
- To tell us your opinions, concerns and complaints.
- To give information when asked to the health plan and contracted Providers that would help improve your health status.
- To use emergency room services only for an injury or illness that you might think may be a serious threat to your life or health.
- To follow the treatment plan agreed upon by you and your Provider.
- To give all the health plan staff respect and courtesy.
- To tell us of any change in address.
If you have questions or concerns about your rights, please call UnitedHealthcare Customer Service at the phone number listed on your member ID card. If you need help with communication, such as help from a language interpreter, customer service can assist you.
The Medicare program has written a booklet called Your Medicare Rights and Protection. To get a free copy, call toll-free 1-800-MEDICARE (1-800-633-4227) or TTY (1-877-486-2048) 24 hours a day, 7 days a week. Or you can access the Medicare website, to order the booklet or print it from your computer.
Appeals and grievances
As a plan member, you may request statistical information on appeals and grievances by contacting the UnitedHealthcare Appeals and Grievances Department:
Phone (toll-free):
FED TFN (TTY 711)
Hours of Operation: Every day, 8 a.m.–8 p.m.
Mail:
UnitedHealthcare
Attn: Appeals and Grievances
P.O. Box 6106
Cypress, CA 90630
Mail Stop: CY124-0157
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