Member Rights and Responsibilities

As a member, you have certain rights. Trillium Medicare Advantage also expects its providers to respect and honor your rights:

  • To be treated with respect and dignity.
  • To receive the right to privacy and non-discrimination as required by law.
  • To join your providers in making decisions about your health care.
  • To refuse any medical service, diagnoses, treatment or health service if you or your parent/guardian objects based on religious or other grounds.
  • To discuss treatment options, regardless of cost or benefit coverage.
  • To seek a second opinion.
  • To receive information about Trillium Medicare Advantage, including:
    • Structure and operations
    • Services and service utilization plans
    • Practitioners and providers
    • Physician incentive plans
  • To make recommendations regarding Trillium Medicare Advantage member rights and responsibilities.
  • To get information about available experimental treatments and clinical trials and how such research may be accessed.
  • To obtain assistance with care coordination from your provider(s).
  • To be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • To express a concern about or Appeal a Trillium Medicare Advantage decision or the care it provides and to get a response in a reasonable period of time.
  • To look at and get a copy of your medical records as permitted by law (one copy free of charge each year) and request they be amended or corrected.
  • To make an Advance Directive.
  • To file any complaint about not following your Advance Directive
  • To choose a provider who gives you care whenever possible and appropriate.
  • To receive accessible health care services comparable in amount, duration and scope to those provided under Medicaid fee-for-service and sufficient in amount, duration and scope to be reasonably expected to achieve the purpose for which the services are furnished.
  • To receive appropriate services not denied or reduced solely because of diagnosis, type of illness or medical condition.
  • Freedom to exercise the rights described herein without any adverse effect on your treatment by Trillium Medicare Advantage, its providers or contractors.
  • To receive all written member information from Trillium Medicare Advantage:
    • At no cost to you.
    • In the prevalent non-English languages of its members in the service area.
    • In other ways, to help with the special needs of members who may have trouble reading the information for any reason.
  • To receive oral interpretation services free of charge for all non-English languages, not just those identified as “prevalent.”
  • To be notified that oral interpretation services are available and how to access them.
  • To get help from Trillium Medicare Advantage in understanding requirements and benefits.

As a member, you have certain responsibilities:

  • To inform Trillium Medicare Advantage of the loss or theft of your Member ID card.
  • To present your Member ID card when using health care services.
  • To be familiar with Trillium Medicare Advantage procedures to the best of your abilities.
  • To call or contact Trillium Medicare Advantage to obtain information and have questions clarified.
  • To provide in-network providers with accurate and complete medical information.
  • To follow prescribed treatment of care recommended by a provider or letting them know the reason(s) treatment cannot be followed, as soon as possible.
  • To make every effort to keep scheduled appointments and follow-up appointments and access preventive care services.
  • To live a healthy lifestyle and avoid behaviors known to be bad for your health.
  • To provide accurate and complete information to all health care providers.
  • To become knowledgeable about Trillium Medicare Advantage coverage provisions, rules and restrictions.
  • To ask questions of your providers to determine the potential risks, benefits, and costs of treatment alternatives and make care decisions after weighing all factors.
  • To understand your health problems and participate in developing mutually agreed upon treatment goals with your provider to the highest degree possible.
  • To follow the Grievance process established by Trillium Medicare Advantage (and as outlined in the Evidence of Coverage) if there is a disagreement with a provider.

Last Updated: 11/30/2017
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