Member Rights and Responsibilities
Member Rights
- Receive information on Oklahoma Complete Health member, plan information including its services, its practitioners and providers and member rights and responsibilities,
- Be treated with respect and with due consideration for dignity and privacy,
- Receive information on available treatment options and alternatives regardless of cost or benefit coverage, presented in a manner appropriate to the Oklahoma Complete Health member’s condition and ability to understand,
- Participate in decisions regarding his or her health care, including the right to refuse treatment,
- Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation,
- Request and receive a copy of their medical records and request that they be amended or corrected, and
- Obtain available and accessible Health Care Services covered under the Contract;
- To voice a complaint or appeal about Oklahoma Complete Health or the care it provides;
- To receive a copy of member rights and responsibilities and the right to make recommendations regarding the rights and responsibilities policy
Member Responsibilities
As a member you have certain responsibilities. Treatment can work better if you do these things. Your responsibilities are:
- To provide Oklahoma Complete Health and participating providers with accurate and complete medical information they need in order to provide care;
- To follow the plans and instructions for care that you have agreed to with your practitioner;
- To understand your health problems and with your provider help develop mutually agreed-upon treatment goals;
- Checking OHCA/Oklahoma Complete Health information; correcting inaccuracies; and allowing government agencies, employers and Providers to release records to OHCA/Oklahoma Complete Health;
- Notifying OHCA/Oklahoma Complete Health within ten days if there are changes in income, the number of people living in the home, address or mailbox changes or health insurance changes;
- Transferring, assigning and authorizing to OHCA all claims the Oklahoma Complete Health member may have against health insurance, liability insurance companies or other third parties. This includes payments for medical services made by OHCA for the Health Plan member’s dependents;
- Working on requests for assistance from the Office of Child Support Services;
- Allowing SoonerSelect to collect payments from anyone who is required to pay for medical care;
- Sharing necessary medical information with any insurance company, person or entity who is responsible for paying the bill;
- Inspecting any medical records to see if claims for services can be paid;
- Obtaining permission for Oklahoma DHS or OHCA to make payment or overpayment decisions;
- Storing his or her identification card and knowing his or her Social Security number to receive health care services or prescriptions;
- Informing Oklahoma Complete Health if his or her member card is lost or stolen;
- Confirming that any care received is covered;
- Understanding Oklahoma Complete Health member responsibility as it pertains to securing NEMT and the timeframes required to receive NEMT services;
- Cost Sharing;
- Ensuring all information provided to OHCA/Oklahoma Complete Health is complete and true upon penalty of fraud; and
- Following the grievances process if you have any concerns about your care