- What are my rights as a member of a Health Plan?
- What can I do if I have a complaint or disagree with a decision?
- Can I change Health Plans if I do not like the one I'm in?
Each member has a right to:
- Be treated with dignity and respect
- Be told by your doctor, nurse, or other provider of the options and alternatives of care offered, in a way that you can understand
- Be told about your health in a language that you can understand and, when needed, in foreign languages, alternative mediums, or other formats
- Ask for and get spoken translations services free of charge
- Tell the Health Plan when you are not happy with a service or a decision
- Complaining without any impact to the services that you get from the Health Plan, doctors, nurses, or other providers
If you are not happy with a service or decision, you have the right to tell the Health Plan filing a grievance or an appeal.
Complaints and Grievances
A grievance is a formal way to tell a Health Plan about a problem with something like customer service.
An appeal is a way to ask to change a decision made by a Health Plan. An example of an appeal is when a Health Plan does not approve a request for a service.
Want to know more about your right to complain or appeal? Look in your Health Plan member handbook under "Grievances and Appeals" or visit your Health Plan's
Not happy with the result of your Health Plan appeal? You can appeal to a unit within the Department whose main job is to hear appeals. Visit the Administrative Appeal Unit for more information on how to file an appeal .
You can change your Health Plan for any reason during the first 90-days you are covered by that the Health Plan.
You can also change Health Plans during the annual open enrollment period.
You can also change your Health Plan at any time when you have "good cause" If you believe you have a good cause, and want to change your Health Plan, contact Medicaid Client Services at (800) 852-3345, ext 4344 (in state) or (603) 271-4344.