Member Rights and Responsibilities
The Member Rights and Responsibilities Statement is published each year in the Evidence of Coverage (EOC) available on the Medica website at medicaplans.com. You may get a copy of the Member Rights and Responsibilities Statement by contacting Network Management Services at 877-670-8432. If your patient has questions about their rights as a Medicare Advantage member, please refer them to the Member Services phone number on the back of their ID Card.
Member Participation in Treatment Options
Members have the right to freely communicate with their physician and participate in the decision making process regarding their health care, regardless of their benefit coverage. Physicians should encourage and provide active member communication and participation in their treatment planning and course of care. This includes the member’s right to withhold resuscitative services or to forgo or withdraw life-sustaining treatment in compliance with federal and state laws.
Each member has the right to receive information on available treatment options (including the option of no treatment) or alternative courses of care and other information specified by law, as applicable. Physicians must communication information, regarding the risks, benefits, and consequences of treatment or non-treatment, at a level the member may understand to decide among the treatment options.
Competent members have the right to refuse a recommended treatment, counsel or procedure. The physician may regard such refusal as incompatible with the continuance of the physician/patient relationship and the provision of proper medical care. If this occurs, and the physician believes that no professionally acceptable alternatives exist, the physician must so inform the member in writing, by certified mail. The physician must give the member 30 calendar days to find another care provider.
During this time, the physician is responsible for providing continuity of care to the member.
For information on advance directives, refer to Chapter 15: Member Rights and Responsibilities.