Member Rights and Responsibilities

Trillium Oregon Health Plan 
Member Rights and Responsibilities Statement

This statement explains your rights and responsibilities as a Trillium Community Health Plan (Trillium) member. As a member of Trillium Community Health Plan, you have certain rights. There are also certain things you are responsible for. If you have any questions about the rights and responsibilities listed here, contact Member Services at 1-877-600-5472. Ask to speak to Care Management.

You have the right to exercise your member rights without any adverse action or discrimination. If you feel like your rights have not been respected, you can file a grievance. You can also contact an Ombudsperson through the Oregon Health Authority at 1-877-642-0450 or TTY 711.

If you believe you have been discriminated against, you may also contact:

Levi Welbourne, Senior Manager, Grievance & Appeals
555 International Way, Building B
Springfield, OR 97477
Phone: 541-485-2155
Toll-free 1-877-600-5472 (TTY 711)
Email: grievances@trilliumchp.com
Please use the link to the Member Satisfaction page for more detailed information.

There are times when people under age 18 (minors) may want or need to get health care services on their own. To learn more, read “Minor Rights: Access and Consent to Health Care.” This booklet tells you the types of services minors can get on their own. It also tells you how minors’ health care information may be shared. You can read this booklet online (PDF)

MEMBER RIGHTS:

As a Trillium member you have the right to:

  • Be treated with dignity, respect, and consideration for your privacy. 
  • You can find out if a provider is accepting new members by looking at the provider directory.
  • Be treated by providers the same way as other people seeking healthcare.
  • Choose your providers and to change those choices.
  • Refer yourself directly to behavioral health or family planning services without getting a referral from your PCP or another provider.
  • Have a friend, family member, or helper come to your appointments.
  • Be involved in creating your treatment plan.
  • Get information about your condition, what is covered, and what is not covered, so you can make good decisions about your treatment. Get this information in your language and in a format that works for you.
  • Accept or refuse treatments and be told what might happen based on your decision. A court-ordered service cannot be refused.
  • Get written materials that tell you your rights, responsibilities, benefits, how to get services, and what to do in an emergency.
  • Get materials explained in a way that you can understand them and in your language.
  • Learn about CCOs and the health care system.
  • Get services that consider your cultural and language needs and are close to where you live. If available, you can get services in non-traditional settings.
  • Get care coordination, community-based care, and help with care transitions in a way that works with your language and culture to reduce the need for hospital or nursing facility visits.
  • Get the services that are needed to diagnose your health condition.
  • Get person-centered care and services that give you choice, independence, and dignity. This care will be based on your health needs and meet generally accepted standards of practice
  • Have a stable relationship with a care team that is responsible for your overall care management. Get help to use the healthcare system and get resources you need. This could include:
  1. Certified or qualified health care interpreters
  2. Certified traditional health workers
  3. Community health workers
  4. Peer wellness specialists
  5. Peer support specialists
  6. Doulas
  7. Personal health navigator
  • Get covered preventative services.
  • Get urgent and emergency services 24 hours a day, seven days a week without prior authorization.
  • Get a referral to specialty providers for covered coordinated services that are needed based on your health.
  • Have a clinical record kept that keeps track of your conditions, the services you get, and referrals.
  • Have access to your clinical records. There may be times when the law restricts your access.
  • Transfer your clinical record to another provider.
  • Have your clinical record corrected or changed to be more accurate.
  • Make a statement of your wishes for treatment. It can have your wishes to accept or refuse medical, surgical, or behavioral health treatment. It can also give instructions and powers of attorney for your care.
  • Get written notice of a denial or change in a benefit before it happens. You may not get a notice if one isn’t required by federal or state regulations.
  • File a grievance or an appeal.
  • Ask for hearing if you disagree with a decision made by Trillium Community Health Plan or OHP.
  • Get certified or qualified health care interpreter services, including sign language interpretation.
  • Get a notice of an appointment cancellation in a timely manner.
  • Not be held down or kept away from people to get you to do something you do not want to do, used as a way to punish you, or make it easier to care for you.
  • Be treated fairly and file a complaint of discrimination if you feel you’ve been treated unfairly because of your:
  1. Age
  2. Color
  3. Disability
  4. Gender Identity
  5. Marital status
  6. Race
  7. Religion
  8. Sex
  9. Sexual Orientation
  • Share information with Trillium Community Health Plan electronically. You can choose to do this or not.

MEMBER RESPONSIBILITIES:

As a Trillium member you have the right to:

  • Choose or help to choose a primary care provider and primary care dentist.
  • Treat Trillium Community Health Plan staff, providers, and clinic staff with respect.
  • Be on time for appointments.
  • Call ahead if you expect to be late or cancel your appointment if you can’t make it.
  • Get your yearly checkups, wellness visits, and preventative care to keep you healthy.
  • Use your PCP for your healthcare needs unless it’s an emergency.
  • Use urgent and emergency care appropriately.
  • Let your PCP know within 72 hours if you used emergency services.
  • Get a referral from your PCP to see a specialist if you need it. There are some cases where you don’t need a referral.
  • Be honest with your providers so they can give you the best care.
  • Help you provider get your health record. You may need to sign an authorization to release your records.
  • Ask questions if anything is unclear.
  • Use information from Trillium Community Health Plan, your providers, or care team to make the best choices for you about your health.
  • Help your provider create your treatment plan.
  • Follow directions from your providers or ask for another option.
  • Let your provider know you have OHP and bring your medical ID cards to appointments.
  • Tell Oregon Health Plan (OHP):
    1. If you change your phone number.
    2. If you change your address.
    3. If you become pregnant and when you give birth.
    4. If any family moves in or out of your home.
    5. If you have any other insurance available.
  • Pay for non-covered services.
  • Help Trillium Community Health Plan get money back from any money you get because of an injury. The amount is only up to what we paid in benefits
  • related to that injury.
  • Bring issues, complaints, or grievances to Trillium Community Health Plan’s attention.