Member Rights and Responsibilities

This includes the right to:

• Be treated with respect and dignity at all times.
• Keep your medical information private.
• Receive services in a culturally competent manner.
• Talk to your Case Manager/Agency or healthcare provider in a place that is reasonably private. People not directly involved with your care may not be present unless you say it is okay.
• Appoint someone else to make health care decisions for you.
• Expect all information and records involving your care, including information about who pays for your treatment, to be kept private and protected. No one may look at your medical information unless he or she is watching over the quality of your health care, or unless you say it is okay.
• Ask AlohaCare or your Case Manager/Agency or healthcare provider to restrict the use and disclosure of your health information.
• Ask for a copy of AlohaCare’s notice of privacy practices.
• Receive medical necessary services, no matter what your age, race, creed, sex, sexual preference, national origin or religion. We will not deny or allow fewer services solely because of your diagnosis, type of illness or health problem.
• Use your member rights and not be treated negatively by AlohaCare. No one may punish you for using your member rights.

This includes the right to:

• Know the name, background, and professional status of your healthcare providers. You have the right to know which doctor is mainly responsible for your care.
• Work with your Case Manager/Agency or healthcare provider to make decisions about your health care.

This includes the right to:

• Work with your Case Manager/Agency or healthcare provider and AlohaCare to set up a treatment plan to receive services in a coordinated manner

• A free second medical opinion from an AlohaCare provider when deciding on treatment.

• An open discussion of appropriate or medically necessary treatment options for your health care conditions, regardless of cost or benefit coverage.

• Know about any experimental, research or educational activities having to do with your care. After you have been given this information, you can choose to participate or not.

• Make comments and suggestions about anything that we do, including making recommendations about our members’ rights and responsibilities, and about our policies and procedures.

This includes the right to:

• Look at and get copies of your medical records, unless your Case Manager/Agency, healthcare provider, or AlohaCare think sharing the information with you may be harmful to you or someone else.
• Ask AlohaCare or your Case Manager/Agency or healthcare provider to correct any medical information you feel is wrong. If your request is denied, you have the right to get the reason for denial in writing.
• Know who sees your medical records, unless the review of your records is for treatment, payment or health care operations (or some other reasons written in the law)
• Make your wishes known when you are not able to make informed choices for yourself.

This includes the right to:

• Timely access to your Case Manager/Agency or healthcare providers you need to see, close to where you live.
• Choose a service provider of your choice among those organizations inAlohaCare’s provider network.
• Get women’s routine and preventive health services from a women’s health specialist without the need for a referral.
• Get appointments with specialists if you have special health care needs.
• Get care from a Case Manager/Agency or healthcare provider r who does not participate with AlohaCare until we can provide a Case Manager/Agency or healthcare provider to care for you.
• Have your doctors work together with you and AlohaCare.
• To get full information about emergency and after-hours services.
• To get the plan’s policy on referrals for specialty care and other benefits that are not provided by the member’s Case Manager / Agency or healthcare provider.
• Have written materials available in alternative formats or other languages.
• Offer timely responses on prior approvals and referral requests.
• To have the use of an interpreter to help you speak to AlohaCare staff or your Case Manager/Agency or healthcare provider or to be there with you when you see your doctor. Interpreter and translation services are free.
• Ask us to send mail and call you at the address or telephone number of your choice, to protect your privacy.  If we cannot do that, we will let you know why.
• Refuse treatment to the extent it is allowed by law. You are responsible for your actions if you refuse medical care or if you do not follow your provider's advice.
• Know the details of any medical treatment for yourself and the minor children in your care. 

This includes the right to:

• Not having to pay for AlohaCare’s debt if AlohaCare goes out of business o Not having to pay for covered services you got if the Med-QUEST Program does not pay AlohaCare.
• Not having to pay for covered services you got if AlohaCare does not pay your doctor.
• Not having to pay extra for covered services you got even if we could have provided the service for less.

No one can make you stay somewhere or keep you away from others unless it is necessary for treatment or your safety.

This includes the right to:

• Make suggestions about AlohaCare’s Member Rights and Responsibilities statement.
• Be informed about HRS 432E Patient's Bill of Rights and Responsibilities.

This includes the right to:

• File an appeal or grievance against AlohaCare or a provider.
• File an appeal or grievance against AlohaCare, the care AlohaCare provides, or a doctor.
• Get a timely response to grievances and appeals.  Exercise these rights without affecting the way we treat you as a member.
• Exercise these rights without affecting the way we treat you as a member.

This includes the responsibility to:

• Tell your Case Manager/Agency or healthcare provider everything you know about your current health, past illnesses, hospital stays, medicines and anything else about your health.
• Tell AlohaCare and your Case Manager/Agency or healthcare provider  if you are taking part in any medical research tests.
• Tell AlohaCare and your eligibility worker if you have a workers' compensation claim, personal injury or medical malpractice lawsuit, or if you have been in a car accident.
• Tell AlohaCare and your eligibility worker if you have any other medical insurance.
• Inform AlohaCare of any other insurance you had when you enrolled with the QUEST program/AlohaCare or any that you get after you become a member of AlohaCare. 
• Tell your child’s PCP about any shots your child already got. This includes immunizations or shots your child got from another clinic or doctor, or when living somewhere else. Always ask your child’s doctor to fill out your child’s immunization record and keep this list with your child’s important papers.

At AlohaCare, our goal is to provide the right drug coverage for our members. We work closely with providers and pharmacists to make sure we offer medications that treat a range of conditions and illnesses. We are proud to work with partners who help us provide innovative and personalized pharmacy solutions. These partnerships help improve member health and make treatments more affordable. They also make sure you have access to important medications and get the support you need through personalized clinical programs.

This includes the responsibility to: 

• Not lend your AlohaCare member ID card or allow others to use your card. You may lose your benefits if you do.
• Have your AlohaCare member ID card with you when you go to see your doctor or go to the pharmacy o Report if you suspect a member or a provider has committed fraud or abuse.

This includes the responsibility to:

Tell AlohaCare and Med-QUEST of any changes including marriage, divorce, birth of a child, adoption of a child, death of a spouse or child, a new job, getting other health insurance or change in your address or phone number.

You may have to share in the cost of your health care or support services. This is based on your Medicaid financial eligibility. If you have a cost-share, you must pay this to one of your providers every month. This is usually a long-term care facility or a home and community-based provider.

Pay for services if you receive care from an out-of-network specialist or provider that is not pre-approved by AlohaCare, or any services that are not covered under the Medicaid program.