Member Rights and Responsibilities
Trillium Oregon Health Plan (Medicaid)
Member Rights and Responsibilities Statement
This statement explains your rights and responsibilities as a Trillium Community Health Plan (Trillium) member.
As a member you have certain rights. You also have the responsibility to be a part of your health care. As your health care partner, we make sure your rights are guarded while we provide your health benefits. This includes providing you access to ournetwork providers and providing information you need to make the best decisions for your health and welfare. We also honor your right to privacy and to receive care withrespect and dignity.
If you are a child or are unable to make choices about your medical care, your legal guardian or agent has responsibility for ensuring your member rights on your behalf.
YOUR MEMBER RIGHTS:
You have the right to have as much information as you need to help you make choices. This includes information about:
- Trillium Community Health Plan.
- The services we provide, including behavioral health services.
- The names and other information about the people who provide you care.
- Your member rights and responsibilities.
- Your medical condition, suggested treatment, and alternative treatments.
- The risks and benefits of suggested treatments.
- Preventive care guidelines.
- Ethical issues.
- How to file a complaint.
We want you to take part in making decisions about your health care. We will make this information as clear and understandable as possible. When necessary we will provide interpreter or translator services.
You have the right to be a part of an open conversation with your health care provider about treatment options for your condition(s), no matter the cost or what benefits are covered. Ask questions, even if you do not think they are important. You should be satisfied with the answers to your questions and worries before agreeing to any treatment. You may refuse any suggested treatment if you don’t agree with it or if it conflicts with your beliefs.
You have the right to be a part of making decisions about your health care with your health care worker. You have the right to choose an adult to act on your behalf, known as an agent or representative, to make medical decisions for you if you are unable to do so, and to express your wishes about your future care. You can shareyour wishes in a paper called Advance Health Care Directive. Please look in your Member Handbook for more information about advance directives.
For more information about these services and materials, please contact Trillium Member Services at the phone number at the bottom of the document.
You have the right to polite treatment. We respect your right to:
- Be treated with respect and honor. Care offered and provided to you will not be based on age, race, ethnicity, color, national origin, cultural background, ancestry, language, religion, sex, gender identity, sexual orientation, marital status, medical condition, including physical or mental disability, type of illness, or financial status.
- Be addressed in a manner that is comfortable to you.
- Know your health care providers. You have the right to ask each person who takes part in your care to introduce himself or herself, state his or her job and explain what he or she is going to do for you.
You have the right to use Interpreter services. When you come in for an appointment or call for advice, we will make every effort to speak with you in the language you are comfortable using. For more information about our interpreter services, please refer to your Member Handbook. You can also call Trillium Member Services at the phone number listed below.
You have the right to have all your medical and financial records kept private according to state and federal law. Every Trillium Community Health Plan employee, doctor, and provider has to keep your protected health information (PHI) private. PHI is information that includes your name, Social Security number, and other information that tells people about who you are, such as race, nationality, and language. For example, your medical record is PHI because it has your name and other private information.
Trillium Community Health Plan has strict policies and procedures about collecting, using and sharing member PHI, including the following:
- Trillium Community Health Plan’s routine uses and disclosures of PHI.
- Use of authorizations.
- The ability to see your PHI.
- Protection of oral, written, and electronic PHI throughout Trillium, and
- Protection of information disclosed to Plan sponsors or employers.
For more information about your rights with PHI and our privacy rules, please refer to our Notice of Privacy Practices, or call Trillium Member Services at the phone number listed below.
You have the right to voice complaints or make appeals about Trillium Community Health Plan or the care we give. The directions on how to make a complaint or an appeal are in Member Handbook. If you need another copy of the Member Handbook or more information about how to make a complaint or appeal, please call Trillium Member Services at the phone number listed below.
You have the right to make suggestions about Trillium’s member rights and responsibilities rules. Members have the right to provide feedback and make recommendations related to the Member Rights and Responsibility Policy
Additional rights you have are:
- Freedom to choose your provider.
- To have yearly check-ups, wellness visits and other services to prevent illness and
- keep you healthy.
- To be given a referral if you need it, or second opinion, if you want it.
- To be given care when you need it, 24 hours a day and 7 days a week.
- To get mental health and family planning services without a referral.
- To get help with addiction to cigarettes, alcohol and drugs without a referral.
- To be given handbooks and letters that you can understand.
- To see and get a copy of your health records.
- To limit who can see your health records.
- To be sent a Notice of Action letter if you are denied a service or there is a change in
- service level.
- Freedom to ask the Oregon Health Authority Ombudsperson for help with problems at (503) 947-2346 or toll free at 1(877) 642-0450.
YOUR MEMBER RESPONSIBILITIES:
You are responsible for letting health care workers know who you are at appointments. You are responsible for bringing your Trillium Community Health Plan identification (ID) card with you to all appointments. Your ID card is for identification only and does not give you rights to be served or be given benefits unless you are a member of our Health Plan.
You are responsible for keeping appointments. You are responsible for promptly canceling any appointment you no longer need or are unable to keep.
You are responsible for being honest and providing, as best you can, information Trillium needs to manage plan benefits and providers and practitioners need to provide care. You should provide a complete medical history. Be sure to tell those who are caring for you exactly how you feel about your health care concerns and the things that are happening to you.
You are responsible for understanding your health problems and taking part in deciding on treatment goals. If you do not understand your illness or your treatment, ask you provider to explain it to you.
You are responsible for following the plans and instructions for care you and your provider or practitioner have talked about. You are also responsible for telling your doctor if you believe you cannot follow your treatment plan.
You are responsible for being thoughtful of other people. You are responsible for treating doctors, health care workers, and other Trillium members politely.
You are responsible for knowing about and using member resources available, like the complaint process. Information about how to make a complaint is in your Member Handbook. If you need another copy, call Trillium Member Services to ask forone.
Trillium Member Services can also tell you about resources available and about Trillium Community Health Plan’s policies and procedures.
For additional information or to request this information in another language or format, please call Member Services Toll Free: 1 (877) 600-5472 or TDD/TTY: 1(877) 600-5473.
Trillium Member Services is available to answer your call directly 8 a.m. to 5 p.m., Monday through Friday (except on holidays).
Trillium Utilization Management (UM) staff is available to answer calls from 8 a.m. to 5 p.m., Monday through Friday (except holidays). UM staff makes decisions based on insurance coverage and medical need. UM staff can be reached by calling Member Services.
Our automated system is available anytime for self-service options, including after hours, weekends, and holidays. Voice messages are reviewed and responded to within one business day. Member Services also has free language interpreter service available for non-English speakers.
MCA_EK03V3 Effective 5/12/2015