Member Rights and Responsibilities

Member Rights

As a member you have certain rights. Oklahoma Complete Health wants to respect your rights and we expect our providers to respect your rights. Your rights are:

• A right to receive information about Oklahoma Complete Health, its services, providers and member rights and responsibilities.
• A right to give your ideas for “Oklahoma Complete Health’s member rights and responsibilities policy.”
• A right to be treated with respect, dignity and privacy.
• A right to get information on care options in a way that you can understand, regardless of cost or coverage.
• A right to participate in decisions about your health care, which includes the right to refuse treatment.
• A right to seek second opinions.
• A right to get help with care management from the PCP's office.
• A right to express a concern or appeal about Oklahoma Complete Health or the care you receive, and to receive a response in a reasonable period of time.
• A right to receive a copy of certain of your health plan records upon request (one copy is free of charge) and to ask that your records be amended or corrected where necessary.
• A right to choose your health professionals and long- term supports and services providers to the extent possible and appropriate, as per 42 CFR §438.6(m).
• A right to be given health care services, as per 42 CFR §§ 438.206 through 438.210.
• A right to get health care services that are similar in amount and scope to those given under Medicaid Fee-For-Service. This includes the right to get health care services that will achieve the purpose for which the services are given.
• A right to get services that are fitting and are not denied or reduced due to:
  • Diagnosis
  • Type of illness
  • Medical condition
• A right to be given information in a manner and format you can understand. This includes:
  • Enrollment notices
  • Informational materials
  • Instructional materials
• A right to treatment options and alternatives
• A right to get free oral interpretation services for all non-English languages.
• A right to be notified that interpretation services are available and how to access them.
• A right to get adequate and timely information on Oklahoma Complete Health’s Physician Incentive Plan upon request.

Member Responsibilities

As a member you have certain responsibilities. Treatment can work better if you do these things. Your responsibilities are:

• Notify Oklahoma SoonerSelect if:

                o Your family size changes,

                o You move out of the state or have other address changes, or

                o You get or have health coverage under another policy, other third party, or there are changes to that coverage

• To inform Oklahoma Complete Health of the loss or theft of an ID card.
• To inform Oklahoma Complete Health, your providers and the State SoonerSelect program of any change of address or phone number.
• To present the Oklahoma Complete Health ID card when using health care services.
• To be familiar with Oklahoma Complete Health procedures to the best of your abilities.
• To contact Oklahoma Complete Health to get information and have questions answered.
• To give Oklahoma Complete Health and participating providers accurate and complete medical information they need in order to provide care.
• To follow care prescribed by the provider or to let the provider know why treatment cannot be followed, as soon as possible.
• To keep appointments and follow-up appointments. To access preventive care services.
• To live healthy lifestyles and avoid behaviors known to be harmful.
• To understand your health problems and participate in developing treatment goals with your doctor and other providers, to the degree possible.
• To make your Primary Care Provider (PCP) aware of all other providers who are treating you, including behavioral health providers. (This is to ensure communication and coordination in care.)
• To learn about Oklahoma Complete Health coverage provisions, rules and restrictions.
• To ask questions of your providers to learn the risks, benefits, and costs of treatment options and to make care decisions after carefully weighing all factors.
• To follow Oklahoma Complete Health’s grievance process outlined in the Member Handbook if you have a disagreement with a provider.
• To choose a PCP.
• To treat providers and staff with dignity and respect.
• Oklahoma Complete Health promotes the delivery of services in a culturally competent manner to all Health Plan members, including those with limited English proficiency and diverse cultural and ethnic backgrounds, disabilities, and regardless of gender, sexual orientation or gender identity.